companion How to pick your way through the jungle of ectoparasite treatments

companion
JANUARY 2012
The essential publication for BSAVA members
How to pick your way
through the jungle of
ectoparasite treatments
for dogs and cats
Syringomyelia
New screening
programme
P4
Clinical Conundrum
Polydipsia in a mixed
breed dog
P8
Pet Travel
Coping with the
new rules
P24
3
4–7
8–11
12–13
14–18
19
Keep benefitting
and carry on
BSAVA News
What is happening in your
association
Syringomyelia scheme
New screening programme
Clinical Conundrum
M
Consider a case of polydipsia in a
mixed-breed dog
ore than 7000 members
enjoyed their BSAVA
benefits last year and we
hope you continue to do so
in the coming year, as you’ll be getting
even more for your money in 2012.
If you have not yet renewed it is
essential to do so as quickly as
possible, as only renewing members
will be eligible for the BSAVA/VPIS
Surgical staplers
A Vicky Lipscomb case study
How To…
Pick your way through the jungle of
ectoparasite treatments
Have we got reviews for you
News from JSAP
20–21 Congress Science
Highlights from the vet and nurse
programme
22
Congress Business
VN membership
Outline of the management
programme
24–26 On the border of change
B
New pet travel rules
27–29
SAVA maintains its introductory offer of £66 for
annual e-vet nurse membership in 2012,
giving VNs the opportunity expand their skills
and benefit from all the online resources
available. So BSAVA now really is an Association for
the clinical team. Membership is a great way to reward
staff and provide resources to the individual that
ultimately benefit the practice. For more information
visit the website or call 01452 726700. ■
WSAVA News
The World Small Animal Veterinary
Association
30–31 The companion Interview
Richard Saunders
32
33
Petsavers
Hormones and hyperthyroidism
Focus on…
Midland Region goes interactive
34–35 CPD Diary
What’s on in your area
Guide to Common Canine and Feline
Poisons. This ‘bonus book’ for
continuing members will be available
for collection from the BSAVA Balcony
at Congress, and will be sent to those
eligible members who aren’t able to
collect in the months following. This is a
thank you for your loyalty and support,
and reinforces the benefits we hope you
take full advantage of this year. ■
Insure your health for less
D
id you know that as a BSAVA
member you get discounts on
your health insurance with WPA
– a leading UK health insurer with
a not-for-profit heritage of over 110 years?
See the leaflet inside this issue or visit the
benefits section in the Membership area at
www.bsava.com. Alternatively, call 0800
298 9 588 and let them know you are a
BSAVA member. ■
Additional stock photography Dreamstime.com
© Alex Kalmbach; © Armando Frazão; © Christopher
Jackson; © Isselee; © Jakub Krechowicz; © Johnbell;
© Marish; © Michael Pettigrew; © Milan Kopcok; © Olivér
Svéd; © Vitaly Titov; © Warren Rosenberg; © Wayne Ruston
companion is published
monthly by the British
Small Animal Veterinary
Association, Woodrow
House, 1 Telford Way,
Waterwells Business Park,
Quedgeley, Gloucester
GL2 2AB. This magazine
is a member only benefit
and is not available on
subscription. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: [email protected]
Web: www.bsava.com
ISSN: 2041-2487
2
| companion
Editorial Board
Editor – Mark Goodfellow MA VetMB CertVR DSAM
DipECVIM-CA MRCVS
Senior Vice-President – Grant Petrie MA VetMB
CertSAC CertSAM MRCVS
■
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA
MRCVS
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
■
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
■
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
BSAVA partners
with SAVSNET
T
he BSAVA has established an
important partnership with the
University of Liverpool to ensure
continued development of a
national UK disease surveillance network
for companion animals.
The Small Animal Veterinary
Surveillance Network (SAVSNET), was
established in 2008 by a team of veterinary
scientists at the University of Liverpool to
monitor the disease status of the UK small
animal population (mainly dog, cat and
rabbit). When funding for the pilot project
came to an end in August last year, BSAVA
believed that not only would the profession
benefit from the continued activity of this
group and that, in fact, it is vital for the
successful management of disease in
small animals.
Key aims of the project are to:
■
■
■
■
■
Monitor disease trends over time
and highlight appropriate
interventions
Identify small animal pet populations
at risk and monitor treatments and
outcomes
Improve general public awareness of
pet diseases and prevention
Provide a system where vets in
practice can compare their disease
and management profile with those
of their anonymised peers
Allow scientists to analyse the data,
■
while maintaining high standards of
data protection and anonymity
Enrol a wider and more representative
sample of veterinary practices from
across the UK.
BSAVA president Andrew Ash said:
“SAVSNET ticks all the boxes for BSAVA.
Disease surveillance gives us the
information to treat animals better, and the
research papers help us inform veterinary
policy and education. This is an important
scheme for both animal and human health.
Furthermore, supporting high quality, large
scale epidemiological research helps us
fulfil our obligations as a charity to
contribute to the public good.”
The impressive team at the University
of Liverpool, led by Alan Radford, will now
roll the scheme out on a national scale and
will be talking to delegates about it at
Congress in April. You can read more
about the pilot scheme, how to get
involved, and plans for the future in the
February edition of companion. ■
Alan Radford
Scottish
tail docking
study
M
embers will be aware of the
Scottish ban on the docking
of working dogs’ tails in 2007
and the campaign by the
Scottish Gamekeepers’ Association
against the introduction of the
legislation. Earlier this year the Scottish
Government commissioned new
research looking at the impact of tail
docking on working gun dogs and
terriers. The first stage of that study is
now complete. However, these interim
results will not be made public and the
final report from the study is not
expected until the middle of 2012.
In the meantime, two further stages
of research will take place and
colleagues in Scotland are encouraged
to contribute. For the second stage dog
owners have already been recruited.
Injuries will be reported, some will be
visited and others working in the same
environment will be monitored as
controls. For the third stage, data from
veterinary practices will be analysed to
capture information on the number and
severity of tail injuries.
Practices across Scotland will
shortly be contacted by the Glasgow
University team, led by Tim Parkin.
You can email Tim at [email protected]
glasgow.ac.uk. ■
Coordinators appointed for
Postgraduate Certificates
B
SAVA is pleased to announce the appointment
of two Programme Coordinators, who will work
closely with the Academic Director and
teachers to support the delivery of the BSAVA
postgraduate certificate programmes.
Professor Jimmy Simpson will be Programme
Coordinator for the medicine programme. Jimmy is
well known in the field of gastroenterology, and has
been a clinician, teacher and researcher at the
University of Edinburgh for many years.
Alasdair Hotston Moore will be Programme
Coordinator for the surgery programme. Alasdair is a
soft tissue surgeon who currently works in private
practice after spending a substantial part of his career
as a clinician and teacher at the University of Bristol.
Both appointees bring to their roles a wealth
of experience in veterinary education and a
passionate belief in the value of accessible and
relevant postgraduate education for those working
in practice. ■
Professor
Jimmy Simpson
Alasdair Hotston
Moore
companion
|3
Syringomyelia
scheme
In the next few months the launch of the
BVA-Kennel Club health screening programme for
syringomyelia, a condition which is most prevalent
in Cavalier King Charles spaniels, is expected. The
scheme is the product of lengthy discussions
between the two organisations on the best way to
control this painful and debilitating disease. But they
must now talk to the Cavalier breeders and
persuade them that this initiative provides the best
hope for restoring the health of a well loved breed.
John Bonner reports
H
ertfordshire dog breeder Margaret
Carter was understandably proud
of her Cavalier King Charles
spaniel Monty. Born in 1992, the
dog became a breed champion at the age
of four and went on to sire at least eight
other champion Cavaliers both in Britain
and abroad.
Then, when he was nine years old,
Margaret was told that one of her dog’s
progeny had been diagnosed with the
recently recognised neurological condition,
syringomyelia (SM). Alerted to the
possibility that Monty was the likely source
of the defective genes that cause this
problem, she was on the look-out for signs
of clinical disease in her dog.
Two years later, Monty began
‘screaming and writhing’ if touched on his
neck. He was euthanased within two
months when the pain could not be
controlled. A post mortem examination
showed the characteristic tubular defects
or syrinx in the spinal cord, postulated to
result from a skull conformation which does
not allow free flow of cerebrospinal fluid
(CSF) through the foramen magnum.
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New approach to not-so-new
condition
As someone who had kept and shown
Cavaliers since the 1970s, Margaret says
that some of the clinical signs now known
to be associated with the condition, such
as scratching and a ‘bunny hopping’ gait,
had been commented on since the 1950s.
However, those practices that breeders
commonly use to preserve a desired trait,
such as line-breeding between closely
related animals, had made the situation
much worse.
More severe signs had started to
become widespread in the breed and to
affect dogs much younger than her own,
which had survived to the age of 11. So,
realising she had played an albeit minor
role in helping to create the problem,
Margaret became active in efforts to deal
with it. She volunteered to serve as Health
Coordinator for the breed club and
organise donations of clinical samples to
Dr Clare Rusbridge, the south Londonbased veterinary neurologist who first
described syringomyelia and the
associated Chiari-like malformation (CM) in
Cavaliers in 1997 and who remains a world
authority on the condition.
Dr Rusbridge’s investigations have
demonstrated just how widespread the
condition is in Cavaliers. The published
prevalence for the breed is an overall 46%
but the disease is a progressive condition
and up to 70% of older dogs appear to
have pathological changes. The numbers
showing overt clinical signs is probably
around 15%. Furthermore the inheritance
of SM associated with CM in CKCS has
shown it to be a complex trait with a
moderately high heritability.
Proposals for the scheme
So given both the prevalence of the
disease and the severity of its clinical
effects, syringomyelia was a particular
focus of the BBC television programme
‘Pedigree dogs exposed’ in August 2008.
This led to the Kennel Club opening its
discussions with the BVA on extending the
range of screening programmes aimed at
tackling the major health and welfare
problems seen in pedigree dog breeds.
Under the scheme agreed by those
two bodies, magnetic resonance images of
the skull and neck will be examined by an
expert panel at a proposed cost of £100.
The results from dogs aged over 2½
years will be entered on a database which
will be maintained by researchers at the
Animal Health Trust. They will compile
estimated breeding values – calculations of
the likely risk of dogs passing on the
condition – based on a statistical analysis
of results in closely related dogs. The initial
scans will be carried out by a network of
veterinary centres with MRI scanners in
Britain and several other countries, that
have agreed to carry them out at significant
discounts on the normal cost of MRI
procedures. Dr Rusbridge, for example, is
hoping to offer scans at the Stone Lion
veterinary hospital in Wimbledon for £200
plus VAT, little more than the cost of the
general anaesthetic used in the process.
Costs at other practices may differ
significantly.
Interested parties
However, there are ten (soon to be 11)
separate breed clubs representing Cavalier
owners and breeders in the UK and only a
couple of these have expressed support
for the scheme. Breeders’ anxiety when too
much attention is paid to the health
problems within the breed predates the
announcement of this health screening
scheme. “Before I became health rep I
hadn’t realised how many breeders had
– or suspected they might have – this
condition in their dogs. There was a belief
that you don’t talk about these things for
fear that it will ruin the breed. I found
myself becoming increasingly unpopular
and was voted off the health rep position
after I agreed to speak to the makers of the
‘Pedigree Dogs Exposed’ programme,”
Margaret recalls.
Cavalier breeders point out, quite
reasonably, that other pedigree breeds
have health problems and so it is unfair for
their breed to be singled out. But as the
documentary explained, at that time
Cavaliers were the sixth most popular
pedigree breed in Britain. Cavaliers are
also affected by a high prevalence of mitral
valve disease, which manifests itself earlier
than in other breeds, as well as single gene
disorders such as curly coat/dry eye and
episodic falling syndrome.
Yet it is syringomyelia that attracts the
most attention because it is so distressing
for those witnessing its effects, as well
as for the dogs themselves. “I have spoken
to people who have a very similar human
condition. They say it is extremely painful
and there is no justification for allowing an
animal to suffer as they do,” said Carol
Fowler, a former teacher who has had two
affected dogs and is now a campaigner
against hereditary canine diseases.
A big challange
Although Cavalier breeders have a good
record in trying to eliminate single gene
ocular diseases in their dogs, the
multigene inheritance and variable onset
of syringomyelia make it a much more
difficult challenge. But if enough scans are
carried out in the scheme, the calculation
of estimated breeding values (EBV) will at
least help to eliminate the influence of
environmental factors which tend to
muddy the water.
But will there be enough cases
entered on to the database to produce
reliable EBVs?
Kennel Club spokeswoman Sarah
Wilde recognises that this may be in
doubt. The 10 Cavalier breed clubs have
at least agreed to put forward a single
representative for discussions with the
Kennel Club and BVA on running the
companion
|5
Syringomyelia scheme
scheme. However, “the Kennel Club has
seen that the breed clubs supports the
scheme in theory but not the publication
of results at this stage (but could do so
in the future). As publication of health
results is an intrinsic part of the new
scheme, it is therefore unlikely that the
clubs themselves will fully support the
scheme but individuals within them might
certainly do so.”
Breeders’ perspectives
Clare Rusbridge points out that the attitude
of the UK Cavalier breed clubs is in stark
contrast to that of breed clubs in
Scandinavia where there is an automatic
presumption that publicising details of
health screening programmes will help to
improve the breed. “The only people that
will benefit from non-publication are those
who have something to hide. It is not
protecting good honest breeders who are
trying to do a good job.”
Another issue for the breed clubs is
their belief that they have not received
enough credit for their efforts in the past,
particularly the large sums that have
already been spent on full cost MRI scans
at more than £1000 a time. “The plan was
for those of us who have had scans done
previously, that meet the criteria of the new
scheme, to submit them and pay a flat fee
to have them read. Unfortunately, most of
them don’t meet the scheme criteria
because the dogs were not microchipped
or the scanning protocol was different to
that being used now. So all that expense
and effort which we undertook in good
faith is now wasted,” said Sheena
Maclaine, Chairman at the Cavalier King
Charles Spaniel Club.
Dr Rusbridge says it is not true that
previous scan results have no value. The
data from earlier MRIs will be included
when Sarah Blott at the Animal Health
Trust, who is collating the data, can be
sure that their inclusion will not bias the
results. Her concern is that only data from
Grade A dogs with no abnormalities will be
submitted, when the important feature of
6
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the BVA scheme is that it includes the
results of all animals scanned. “We are
trying to produce the tools that will help
breeders but we have to have the right
data,” Dr Blott explains.
Clare feels that many breeders
misunderstand the nature of the scheme.
They believed that the BVA would issue a
health certificate for those dogs that have
already been scanned and found to be
clear. But this is a progressive disease and
the value of a scan carried out as a young
dog will gradually diminish as it gets older,
she says.
No cure-all
Dr Rusbridge also warns supporters of the
screening scheme that it is not a panacea
for the health problems that exist in the
Cavalier breed – or indeed the other
breeds in which the condition is known to
occur, such as King Charles spaniels,
Griffon Bruxellois, Affenpinschers,
Yorkshire terriers, Maltese terriers,
Chihuahuas, Pomeranians and Papillions.
The ultimate aim must be to identify the
specific genes involved in the disorder and
produce a specific test.
Indeed, any breeding programme
that has to exclude about 50 per cent
of the population, as would seem likely
in this case, is likely to generate further
problems by creating a genetic bottleneck.
“So I don’t think it is realistic to aim for the
elimination of this condition. What we can
do is to reduce the prevalence and
severity, and to extend the age of onset.
In effect, we should be trying to return to
the situation which probably existed with
the breed in the 1950s and 1960s,”
she suggests.
Given the scale of the health problems
in the breed, there are some like Carol
Fowler who would argue that the only
hope is to allow outcrossings with closely
related breeds, a strategy that was
sanctioned by the Kennel Club to help
Dalmatian breeders affected by problems
with uric acid metabolism. This, of course,
would be anathema to those who have
dedicated their lives to raising pure-bred
Cavalier puppies.
Dr Rusbridge also doubts that it would
provide a practical solution. She points out
that syringomyelia has been recorded in
Cavaliers crossed with other breeds.
Furthermore, because the Cavalier brain is
the same size as a Labrador, the only way
to make sure crossbreed puppies have
sufficiently large skulls is to mate the
Cavalier with something the size of a
Springer spaniel and the result may be
nothing like the two parent dogs.
Is there hope?
So is there any point in putting all this
effort into trying to save the Cavalier
breed? Dr Rusbridge insists that it is
worthwhile. “They are engaging little
dogs with an excellent temperament
and they are likely to remain popular if
puppy buyers can be given some
reassurance that they will get a healthy
animal”, she says.
However, Sheena Maclaine
acknowledges that the controversy over
the health of Cavaliers has had damaging
effects on its reputation and reduced
demand for the puppies. The recession
has further hurt the prospects for pedigree
breeders, who are now being asked to pay
significant sums to screen their pups and
yet still compete in this shrinking market
with the products of low cost puppy
farming operations.
Dr Rusbridge points out that
breeders are not being asked to bear
the costs of maintaining the health
scheme by having every single puppy
tested. “That is the advantage of the EBV
concept, if data from enough dogs are
included on the database. You won’t have
to scan every puppy in every litter as the
grandparents’ EBVs will give you much of
the information that you need and the
quality of that information will improve
generation by generation.”
So in the meantime, it is a responsibility
of veterinary practitioners to try to educate
prospective puppy buyers to avoid the
health risks of farmed puppies and
support the efforts of reputable breeders.
Clare says; “Practitioners can make an
important contribution by steering their
clients towards those breeders that have
made this investment in the health of
their breed.” n
Clare rusbridge desCribes the pertinent features of syringomyelia
Syringomyelia (SM) is characterised by fluid
filled cavities (a syrinx or syringes) within
the spinal cord. SM occurs secondary to
obstruction of the flow of fluid (cerebrospinal
fluid or CSF) around the spinal cord especially
if that obstruction is at the junction between
the skull and the neck bones (foramen
magnum). The most common predisposing
cause in the dog is Chiari-like malformation
(CM) (Figure 1). The primary clinical sign of
CM/SM is pain, either due to obstruction of
the fluid and/or a neuropathic pain syndrome
due to damage to the spinal cord.
figure 1: t1W mid-sagittal mri scan from a
dog with Cmsm (fluid = dark grey)
Chiari-like malformation (CM) is a
condition characterised by mismatch in
volume between the brain (too big) and the
skull (too small) such that the cerebellum and
brain stem are herniated into or through the
foramen magnum (Figure 2).
CliniCal signs and diagnosis
of syringomyelia and Chiari
malformation
The most important and consistent clinical
sign of CM/SM is pain – however, this may
be difficult to localise. Owners may describe
postural pain, for example pain on jumping
or being picked up. Sleeping with the head
in unusual positions may be reported. Pain is
positively correlated with syrinx width
and symmetry i.e. dogs with a wider
asymmetrical syrinx are more likely to
experience discomfort, and dogs with a narrow
symmetrical syrinx may be asymptomatic.
Syrinxes can progressively expand and a
dog which is asymptomatic in early life may
eventually become painful.
Dogs with a wide syrinx may also scratch,
typically on one side only, while the dog is
walking and often without making skin contact.
Such behaviour is often referred to as an “air
guitar” or “phantom” scratching. Dogs with
a wide syrinx are also more likely to have
curvature of the spine (scoliosis).
SM may result in other neurological deficits
such as weakness and poor coordination.
Seizures, balance (vestibular) disorders, facial
nerve paralysis (Bell’s palsy) and deafness may
also be seen; however, no direct relationship
has been proven and this association may be
circumstantial. CM alone appears to cause
significant head and spinal pain in some dogs.
Magnetic resonance imaging (MRI) is essential
for diagnosis and determining the cause and
extent of SM.
treatment
The main treatment objective is pain relief
and dogs may be medically and/or surgically
managed. There is no cure and at best
treatment improves signs. The clinical signs of
CM/SM are often progressive.
The most common surgical management
is cranial/cervical decompression (also
described as foramen magnum or suboccipital
decompression) in essence creating more
space for the brain by removal of bone. There
are three main drugs used for treatment of
CM/SM: drugs that reduce CSF production
e.g. cimetidine or omeprazole or possibly
diuretics such as furosemide; analgesics; and
figure 2: Comparison between the caudal
cranial fossa and foramen magnum in a
normal dog (left) and a dog with Cm/sm
(right). the images on the top are mid-sagittal
t2W images of the caudal cranial fossa and C1
(fluid = white). the images on the bottom are
transverse t2W images at the level of
foramen magnum. the normal dog has an
unobstructed foramen magnum evident by
the clear ring of “white” fluid around the
spinal cord. in the dog with Cm/sm the
foramen magnum is obstructed by herniated
cerebellum and brain stem.
corticosteroids. Simple actions, for example
raising the food bowl and removing neck
collars, can also help.
More information from Clare Rusbridge
about syringomyelia can be found at
www.veterinary-neurologist.co.uk. Also, as
more detail about the Kennel Club scheme
becomes available BSAVA will add this
information to its website (www.bsava.com).
companion
|7
Clinical conundrum
Theresa McCann of Davies Veterinary Specialists
invites companion readers to consider a case of
polydipsia in a mixed-breed dog
Case presentation
A 5-year-old female neutered
mixed-breed dog presented with a
48-hour history of abdominal
enlargement. Four weeks
previously the dog had experienced
polyuria/polydipsia, lethargy and
pyrexia. Treatment with amoxicillin
clavulanate resulted in resolution
of the pyrexia and lethargy but the
polyuria/polydipsia persisted. At
presentation the dog was bright
with a good appetite and no other
abnormalities were reported.
Physical examination
The dog was bright, alert, responsive and
body condition was good (BCS 4/9).
Mucous membranes were pink and moist
with a CRT of <2 s. Heart rate was 120 bpm
with good pulse quality. Respiratory rate
was 28 breaths per min. Thoracic
auscultation was unremarkable. There was
moderate abdominal distension with a
positive fluid thrill but no palpable
discomfort or masses. Rectal temperature
was 38.3°C and systolic blood pressure
was 150 mmHg.
Construct a problem list and
discuss the pertinent differential
diagnoses
Polyuria/polydipsia (PU/PD) –
Polydipsia can be the primary abnormality
(psychogenic polydipsia) or compensatory
8
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to polyuria. Impaired renal concentrating
ability, resulting in polyuria, can result from
solute (chronic renal failure, diabetes
mellitus, primary glucosuria) or water
diuresis (pyelonephritis,
hyperadrenocorticism,
hypoadrenocorticism, hypercalcaemia,
hypokalaemia, hepatic disease, primary
nephrogenic diabetes insipidus).
Abdominal distension can result from
organomegaly, organ distension, an
abdominal mass or effusion. Causes of
abdominal effusion include transudate,
modified transudate, exudate, blood, chyle,
bile and urine. As the dog was clinically
well and a fluid thrill was palpable, a
transudate or modified transudate
abdominal effusion was most likely.
Describe your initial diagnostic
investigation of this case.
Initial investigation was aimed at narrowing
the differential diagnoses for PU/PD and
determination of the nature of the
abdominal fluid. In the majority of cases, a
combination of urinalysis and serum
biochemistry can achieve the former, and
evaluation of a sample obtained by
abdominocentesis the latter.
Evaluate the haematology,
biochemistry, urinalysis and
abdominal fluid analysis and
revise your problem list
accordingly
Classify the abdominal fluid as a
transudate, modified transduate or exudate.
Hypoalbuminaemia can result from
increased loss (protein-losing
nephropathy (PLN), protein-losing
enteropathy (PLE), burns, external
haemorrhage, vasculitis), decreased
production (liver disease, malnutrition,
maldigestion, malabsorption) or
sequestration of albumin into a body cavity.
Hypocalcaemia is an expected finding in
dogs with hypoproteinaemia due to a
reduction in the protein bound fraction.
With PLE hypocalcaemia may develop
due to calcium malabsorption or
secondary to vitamin D deficiency or
hypomagnesaemia. Additional causes of
hypocalcaemia (renal failure, pancreatitis,
ethylene glycol toxicity, primary
hypoparathyroidism) were excluded given
the history, clinical findings and normal
inorganic phosphate level. Clinical signs of
hypocalcaemia were not present and
ionised calcium was not assessed.
Hypercholesterolaemia can arise as a
result of increased cholesterol production
(nephrotic syndrome), decreased lipolysis
(hypothyroidism) or by multiple
mechanisms including obstruction
(pancreatitis, cholestasis, diabetes
mellitus, hyperadrenocorticism).
Proteinuria can arise from non-urinary
(physiological or pathological) or urinary
causes (renal, parenchymal, tubular,
glomerular and non-renal). Significant
proteinuria and non-inflammatory
urinary sediment combined with
hypoalbuminaemia is indicative of
glomerular proteinuria (PLN). Generally
PLN is associated with hypoalbuminaemia;
in this case panhypoproteinaemia was
present. As there was no evidence of blood
loss or burns, either the glomerular damage
was severe enough to allow leakage of
large molecular weight globulins as well as
albumin into the urine, or occult concurrent
Haematology (units)
Reference range
Measured value
RBC count (x1012/l)
5.50–8.50
6.49
Haematocrit (l/l)
0.39–0.55
0.46
Haemaglobin (g/dl)
12.00–18.00
16.80
MCV (f/l)
60.00–77.00
71.00
32.00–36.00
34.70
MCHC (%)
Platelets (x10 /l)
200.00–500.00
387.00
Total WBC count (x109/l)
6.00–15.00
14.10
Neutrophils (x109/l)
3.60–12.00
11.57
9
Lymphocytes (x10 /l)
0.70–4.80
0.99
Monocytes (x10 /l)
0.00–1.50
0.42
Eosinophils (x109/l)
0.00–1.00
0.14
Basophils (x109/l)
0.00–0.20
0.00
9
9
Table 1: Routine haematology
Parameter
Result
Apperance
Dark yellow, clear
Protein
++++
pH
6.5
Blood
++
Negative
Biochemistry (units)
Reference range
Measured value
Ketones
Total protein (g/l)
58.00–73.00
30.40
Bilirubin
Negative
Albumin (g/l)
26.00–35.00
13.30
Glucose
Negative
Globulin (g/l)
18.00–37.00
17.10
Specific gravity (refractometer)
1.040
5.70
Sediment examination
Numerous red blood cells,
occasional white blood cells
(1–2 phpf). Numerous hyaline
and occasional granular casts
Urine protein:creatinine ratio
(reference range <0.5)
3.39
Urine culture (cystocentesis
sample obtained during
ultrasound examination)
Negative
Fibrinogen (g/l)
2.00–4.00
ALP (IU/l)
20.00–60.00
22.00
ALT (IU/l)
21.00–102.00
15.00
Bile acids (µmol/l)
0.00–7.00
0.10
Total bilirubin (µmol/l)
0.00–6.80
0.70
Glucose (mmol/l)
3.00–5.00
4.90
Creatinine (µmol/l)
40.00–132.00
87.00
Urea (mmol/l)
1.70–7.40
5.60
Cholesterol (mmol/l)
3.80–7.00
7.80
Inorganic phosphate
(mmol/l)
0.90–2.00
1.70
Calcium (mmol/l)
2.30–3.00
Table 3: Urinalysis – voided sample (abnormal results in bold). phpf = per
high power field
Parameter
Result
Appearance
Yellow–orange, clear, non-viscous
2.00
Specific gravity
1.008
0.4 g/l
Corrected calcium (mmol/l)
2.30–3.00
2.54
Total protein
Chloride (mmol/l)
99.00–115.00
115.00
Nucleated cell count
0.7 x109/l
Potassium (mmol/l)
3.60–5.60
3.80
Cytology
Sodium (mmol/l)
139.00–154.00
149.00
Occassional activated mesothelial
cell, eosinophil and nondegenerate neutrophil
Table 2: Serum biochemistry (abnormal results in bold)
PLE was present. Reported urinalysis
findings in PLN include microscopic
haematuria (15–18% of cases), granular
(21–35%) and hyaline (7–21%) casts, all of
which were present in this case. Adequate
urine concentrating ability (USG 1.040) and
normal water intake (30 ml/kg/day)
indicated that the polyuria/polydipsia had
resolved or was relative in comparison to
the historical water intake.
The abdominal effusion was a pure
transudate consistent with the level of
hypoalbuminaemia.
Table 4: Abdominal fluid analysis
The combination of hypoalbuminaemia,
proteinuria, hypercholesterolaemia and
ascites indicates that nephrotic syndrome
is present.
What are the differential
diagnoses for PLN and how
would you investigate this case
further?
Diseases associated with glomerular
proteinuria are numerous: bacterial
(borreliosis, chronic infections (e.g.
endocarditis), discospondylitis); protozoal
(babesosis, leishmaniosis); rickettsial
(ehrlichiosis); parasitic (dirofilariasis);
fungal (blastomycosis,
coccidioidomycosis); viral (canine
adenovirus-1); inflammatory (e.g. chronic
dermatitis, periodontal disease,
pancreatitis); systemic lupus erythematous
(SLE) or other immune-mediated disease
(e.g. polyarthritis); neoplasia (lymphoid
and carcinomas); miscellaneous
conditions (corticosteroid excess, toxins,
drugs); hypertension; amyloidosis;
familial; and idiopathic.
companion
|9
Clinical conundrum
Thoracic radiography and abdominal
ultrasonography were performed to look for
evidence of pleural effusion, neoplasia or
chronic infectious/inflammatory diseases.
Radiography was unremarkable but
splenic changes were seen with
ultrasound. Spontaneous contrast in the
splenic vein raised the possibility of
thromboembolic disease or increased
blood viscosity. Hyperviscosity associated
with PLN is attributed to a relative increase
in higher molecular weight proteins and
reduced plasma volume. Ultrasonography
excluded gross intestinal disease. Faecal
alpha1-antitrypsin would have been
valuable in excluding PLE but is not readily
available and was not performed.
Testing for infection and inflammatory
diseases, which can cause glomerulopathy
was performed. Negative antinuclear
antibody serology did not exclude but
made SLE less likely. Borrelia and Ehrlichia
PCR was negative. Babesiosis,
leishmaniosis, dirofilariasis and fungal
diseases are not endemic in the UK and
were excluded as the dog had not travelled
outside the UK. Current vaccination status
excluded canine adenovirus-1. Clinical
examination did not support a diagnosis of
endocarditis or discospondylitis; however,
these differentials cannot be completely
excluded as spinal radiography and
echocardiography were not performed.
Remaining differentials for the PLN
included idiopathic, amyloidosis, familial
and toxic causes. Differentiating these
would influence treatment and therefore
renal biopsy was indicated. Normal buccal
mucosal bleeding time and normal clotting
times indicated that the risk of haemorrhage
after biopsy was not increased.
Ultrasound-guided Tru-cut renal biopsy
was performed under general anaesthesia
without complication. The histopathological
diagnosis of membranous nephropathy
was tentatively supported after initial
electron microscopy evaluation, but the
changes were unusual and the opinion of a
human nephropathologist was sought. A
final diagnosis of mesangioproliferative
glomerulopathy (MPGN) was made
(Table 5); aetiology was unknown.
10
| companion
How would you treat this case?
Glomerluar proteinuria is most commonly
secondary to soluble antigen–antibody
complexes or antigen deposited within
glomerular capillary walls causing
complement activation, production of
proinflammatory cytokines, vasoactive
substances and growth factors, and
recruitment of inflammatory cells resulting
in an alteration in glomerular
permselectivity and proteinuria. As with
many cases the aetiology in this case was
undetermined. Treatment was aimed at
reducing and managing the complications
of proteinuria (ascites, thromboembolism,
malnutrition, azotaemia).
Treatment
n
n
Benazepril (0.5 mg/kg orally q24h)
Low-dose aspirin (0.5 mg/kg orally
q24h)
n
n
n
Moderate protein diet (mixture of a
commercial adult food (Pedigree) and
renal diet (Hill’s k/d))
Predisolone (1 mg/kg orally q24h)
Spironolactone (2 mg/kg orally q24h).
Benazepril, aspirin and the moderate
protein diet were started following renal
biopsy. Angiotensin-converting enzyme
inhibitors are the primary treatment for PLN
when the aetiology is unknown. They have
been shown to reduce proteinuria and
delay the onset of progression to azotaemia
in dogs with idiopathic glomerulonephritis.
Low-dose aspirin selectively inhibits platelet
cyclo-oxygenase (and therefore
thromboxane production, which induces
platelet aggregation) without preventing the
beneficial effects of prostacyclin formation.
A positive effect in dogs on reducing
proteinuria has been shown. Low protein
Technique
Result
Histopathology
Nine glomeruli are present in total indicating an adequate sample size.
There is minimal, multifocal infiltrate of lymphocytes and plasma cells in the
interstitium and regenerative change is present in a single tubule. There is
mild segmental thickening of the basement membrane in most glomeruli.
There is no evidence of glomerular fibrosis or amyloidosis.
Conclusion: Mild segmental thickening of the basement membrane in most
glomeruli is supportive of a mild membranous glomerulopathy. There is a
minimal concomitant chronic tubulointerstitial nephritis.
Electron
microscopy
(final report not
available until
day 42)
Abnormal glomerular basement membrane with podocyte effacement.
There is suspicion that some membrane splitting may be present. There is no
obvious inflammatory component to the changes. The changes are segmental
in nature and most likely reflect a mesangiocapillary glomerulopathy. There is
no associated inflammation making an immune-mediated reaction unlikely.
Table 5: Renal biopsy
glomerulus
gbm1
Parameter (units)
Reference range
Measured value
day 14
PCV (%)
day 22*
day 36
day 58
day 70†
day 123
day 190‡
day 197
37.0–55.0
39.2
44.5
30.2
Platelets (x10 /l)
200.00–500.00
254
284
307
Albumin (g/l)
22.0–29.0
15
13
13
11.5
15
16
Globulin (g/l)
25.0–45.0
33
29
26
25.8
29
35
Creatinine (µmol/l)
44.0–159.0
118
105
115
88.2
122
332
378
Urea (mmol/l)
2.5–9.6
8.8
6.5
9.2
11.1
19.0
25.7
26.9
Cholesterol (mmol/l)
2.8–8.2
8.9
8.9
7.6
9.9
9.6
Inorganic phosphate
(mmol/l)
0.81–2.19
1.87
1.52
2.21
2.20
1.84
2.99
Calcium (mmol/l)
1.98–3.00
2.21
1.86
2.08
2.27
2.32
2.32
Urine protein:creatinine
ratio
<0.5
Systolic blood pressure
(mmHg)
<160
210
180
180
9
11.1
12.8
17
5.07
9.45
Table 6: long-term follow up information (abnormal results in bold). *Prednisolone started then reduced and stopped after day 58; †amlodipine started;
‡ aluminium hydroxide phosphate binder started
diets can reduce proteinuria and delay
death due to renal failure. In this case the
hypoalbuminaemia was severe and it was
felt that a low protein diet would result in
protein malnutrition. A combination of
maintenance and renal diet was fed to give
a moderate protein intake.
Outcome
For financial reasons albumin rather than
urine protein:creatinine ratio was
predominantly used to assess the response
to treatment. After three weeks there was
no change in the albumin level (Table 6)
and prednisolone treatment was started.
Immunosuppressive treatment is beneficial
in 50% of human patients with membranous
nephropathy, but is of little benefit in adults
with MPGN. In dogs with glomerulonephritis
ciclosporin treatment has not been shown
to reduce proteinuria or improve survival.
The general consensus for dogs appears
to be that response to immunosuppressive
treatment is poor and may be detrimental
when prednisolone is used as this drug
may worsen proteinuria. However, due to
the findings in human medicine, some
authors have recommended trialling
immunosuppressive treatment in dogs with
membranous nephropathy. In this case
after a further five weeks prednisolone was
stopped as albumin levels were
unchanged, significant proteinuria
persisted (UPC = 9.4) and the final
diagnosis of MPGN had been reached.
Spironolactone, an aldosterone
antagonist diuretic was used when
necessary to control the ascites and
subcutaneous oedema. Eventually
hypertension (which was managed with
the calcium channel blocker amlodipine)
and progressive azotaemia developed and
the dog was euthanased eight months
after presentation. n
wSAvA RenAl STAndARdizATion STUdy gRoUP
The WSAVA Renal Standardization Study Group comprises 19 internationally recognised scientists
in companion animal nephrology whose aim is to form a consensus on the diagnosis of canine
glomerular disease. The group’s work is still in its early stages and practitioners are encouraged to
consult the WSAVA website for further information and guidance on submission criteria.
The purpose of this initiative is to use all three diagnostic modalities (microscopy,
immunohistochemistry and electron microscopy), as used in human nephropathology, to
accurately characterise glomerular disease in proteinuric dogs and to relate these findings to
clinicopathological presentation and outome.
This proposal achieves this objective by establishing an international network of cooperating
diagnostic renal pathology service centres to systematically evaluate tissue specimens
obtained from proteinuric dogs worldwide and collect information about the clinical and
clinicopathological features of their illnesses. The long-term goal of this study is to better
understand and evaluate and thus optimise the medical management of dogs with proteinuric
renal disorders by identifying distinct glomerular diseases for which specific prognoses and
therapeutic guidelines can be provided.
For updates on the Renal Standardization Study Group please visit the WSAVA website –
www.wsava.org.
companion
| 11
Surgical
staplers
Surgical staplers are used increasingly in a wide
variety of veterinary procedures and may reduce the
potential morbidity associated with surgery, which is
particularly useful in animals that are critically ill. Vicky
Lipscomb, Senior Lecturer in Small Animal Surgery at
the RVC and co-editor of the brand new BSAVA
Manual of Canine and Feline Surgical Principles,
outlines a case study
CaSe
Thor – a 6-year-old male
neutered Great Dane
Presentation and stabilisation
Thor was referred for suspected gastric
dilatation and volvulus (GDV). On
presentation he was recumbent, retching
white froth and had a very distended,
tympanic abdomen. He was tachycardic
with poor quality, irregular pulses.
An ECG confirmed ventricular
tachycardia with a rate of 200 bpm. Two
large bore catheters were placed in the
cephalic veins and a blood sample was
obtained for a PCV/TP, electrolytes, lactate
and venous blood gas analysis.
Intravenous fluid resuscitation was started
with boluses of a crystalloid and 7.5%
hypertonic saline.
Thor’s mucous membrane colour,
capillary refill time, heart rate, pulse quality
and blood pressure were monitored to
assess the response to the intravenous
fluids. A right lateral radiograph confirmed
the diagnosis of GDV and as much air as
possible was removed from the stomach
via gastrocentesis. When Thor’s vital signs,
ECG rhythm, blood pressure and lactate
concentration showed that perfusion had
been improved sufficiently, he was
12
| companion
anaesthetised for surgery using the
minimum amount of fentanyl and
midazolam necessary to achieve
intubation, followed by maintenance of
anaesthesia with isofluorane.
Surgery
Coeliotomy revealed a large distended
stomach twisted 180 degrees in a
clockwise direction. Gastrocentesis was
performed intraoperatively to enable
de-rotation of the stomach. A large bore,
lubricated stomach tube was passed to
empty and lavage the stomach. A large
portion of the fundus and greater curvature
of the stomach was not viable due to its
dark black/blue colour (Figure 1).
Abdominal exploration revealed the head
of the spleen also looked non-viable due to
its black colour.
Figure 1
Options
Options for the removal of the unviable
portion of the stomach included:
1. Conventional open gastric resection
and closure with two layers of a
continuous appositional suture pattern.
2. Inversion of the necrotic portion of the
stomach with two layers of an inverting,
continuous suture pattern.
3. Resection and anastomosis with a
linear and/or linear cutter stapler.
Open gastric resection and
anastomosis exposes the contents of the
stomach to the abdomen and is a relatively
lengthy procedure to undertake in a
critically ill animal. Gastric inversion is
quicker and avoids abdominal
contamination, but sloughing of large
portions of necrotic stomach into the
gastrointestinal tract has been associated
with life-threatening haemorrhage due to
postoperative melaena. Gastric resection
and anastomosis using stapling equipment
was chosen in this case because it is a
rapid, efficient method that avoids
contamination of the abdomen with gastric
contents and the complications reported
with gastric inversion. The stapled gastric
incision was oversewn with a single
inverting continuous suture pattern in case
of undetected mucosal necrosis
underneath a viable looking serosa.
Stapling equipment
A linear or linear cutter stapler could have
been used. A linear cutter stapler (Figure
2) was chosen for convenience as it cuts
off the necrotic stomach as well as
stapling the edges of both the remaining
stomach and resected necrotic portion
(Figure 3). The linear cutter stapler fires
two rows of staggered, B-shaped, titanium
staples either side of the incision. Two
overlapping 80 mm long staple lines were
required to complete the gastric resection
and anastomosis.
thermal sealing device, such as a
LigaSure/Force Triad Energy Platform
system, which can also be used on vessels
up to 7 mm wide.
The splenic artery and vein were very
large in this patient so were double ligated
with absorbable synthetic ligatures on
each side before transection of the vessels
with scissors.
Figure 2
PRINCIPLES OF APPLICATION OF
SURGICAL STAPLERS
■
■
■
■
■
Figure 3
The necrotic spleen could have been
removed using multiple conventional
ligatures, but a ligate and divide stapler
(LDS; Figure 4) was used to save time in
this critically ill patient. The LDS stapler
places two U-shaped staples around the
vessel and divides the tissue between
them. Vessels up to 7 mm wide that may
be compressed to 0.75 mm can be safely
secured using an LDS stapler. Another
option for rapid splenectomy is to use a
Figure 4
■
■
Do not staple tissue that is inflamed,
oedematous or not viable.
Every staple must penetrate all layers of
the tissue.
Choose the correct staple size. In
particular, the tissue must not be too
thick or too thin for the closed staple to
hold it securely.
Do not place excessive amounts of tissue
in the stapler.
Inspect the tissue before firing to ensure
that it is correctly aligned within the
stapler and that no other tissue is caught
up in the stapler.
Carefully remove the stapler after firing,
so as not to disrupt the staple or the
staple line.
Inspect the staple or staple line for
haemorrhage, leakage or loose staples,
especially at both ends of a staple line.
Closure
A right-sided incisional gastropexy was
performed followed by routine closure of
the abdomen. The long exploratory
laparotomy skin incision (xiphoid to pubis)
was closed using skin staples for speed.
Rapid closure of skin wounds can be
achieved using skin staples without
increasing the risk of wound infection or
delaying wound healing. As for skin
sutures, all the wound tension should be
borne by the underlying tissues and not
the skin staples. In Thor’s case an
intradermal suture layer placed prior to skin
stapling placed the skin edges in close
apposition, producing an ideal wound for
skin stapling.
Outcome
Thor recovered well from surgery, began
eating the following day and was
discharged on the fourth postoperative
day. Improvements in outcome following
surgical treatment for GDV, from 50%
mortality 20 years ago to around 90%
survival currently, are largely due to the
significant improvements in stabilisation
and critical care of these animals.
However, the ability to perform a rapid,
efficient surgery using stapling equipment
is helpful and may decrease morbidity and
mortality in those animals that require
gastric resection and splenectomy. Equally,
it should always be remembered that using
stapling equipment does not compensate
for inadequate surgical technique, and the
basic principles of soft tissue surgery and
the principles of application of surgical
staplers must be followed. ■
NEW FROM BSAVA
Member price £49
Non-member price £75
The BSAVA Manual
of Canine and Feline
Surgical Principles
provides a solid
grounding in best
practice for the basic
tenets of veterinary surgery. In addition to
a chapter dedicated to surgical staplers, the
Manual also covers:
■
■
■
■
Preoperative stabilisation
Fluid therapy and electrolyte and
acid–base abnormalities
Shock, sepsis and SIRS
Postoperative management.
Purchase your copy online at
www.bsava.com or contact our
Membership and Customer Services Team
on 01452 726700 to place your order.
companion
| 13
How to pick your way
through the jungle of
ectoparasite treatments
for dogs and cats
Peri Lau-Gillard, who
operates as a freelance
dermatologist in the
South West with clinics
at Cave Veterinary
Specialists, Rowe
Veterinary Group and
Vale Vets, reminds us
of the particular
properties of the
products on offer for
controlling ticks, mites
and insects of
veterinary importance
T
his article provides a brief summary
of the various active ingredients
and formulations of insecticides
and acaricides currently authorized
for use in dogs and cats in the United
Kingdom, in order to help the busy
practitioner to find his/her way through the
jungle of products available. Although
legislation for pets entering the UK no
longer requires tick treatment, travelling
pets are still at risk of contracting ‘exotic’
diseases such as ehrlichiosis, dirofilariasis
(heartworm) and leishmaniosis when
abroad through contact with the arthropod
vectors and should be protected
appropriately. For more information on
changes to the legislation regarding
treatment of travelling pets please see the
article on p24 of this issue of companion.
Imidacloprid + moxidectin
(Advocate spot on®, Bayer plc)
■
Insects of veterinary importance in small
animals include fleas, chewing and
sucking lice, mosquitoes and certain flies
(e.g. phlebotomine sandflies).
■
■
■
Advantages: Adulticidal activity against
fleas on contact within 24 hours;
larvicidal in environment; authorized for
flea control in rabbits; will control biting
lice in dogs.
Disadvantages: No repellent (antifeeding) action; reduced efficacy after
bathing/swimming; occasional
application site reactions.
Comments: The only flea product
authorized for use in rabbits.
Imidacloprid + permethrin (Advantix
spot on for dogs®, Bayer plc)
■
| companion
■
Insecticides
Imidacloprid (Advantage spot on®,
Bayer plc)
14
■
Advantages: Adulticidal activity against
fleas on contact within 24 hours;
larvicidal in environment; acaricidal
and repellent efficacy against ticks for
3 weeks; repellent activity against
sandflies for 2–3 weeks; repellant
activity against mosquitoes for 2–4
weeks; repellant activity against stable
flies for 4 weeks.
Disadvantages: Reduced efficacy after
bathing/swimming; occasional
application site reactions.
Comments: Do not use on cats (toxic).
Has repellent activities.
■
■
Advantages: Control of canine
Sarcoptes and Demodex mites, feline
and canine Otodectes mites, feline and
canine roundworm and hookworm,
canine whipworm, and canine biting
lice. Authorized for the prevention of
heartworm (active against L3 and L4
larvae of Dirofilaria immitis) in dogs,
cats and ferrets. Prevention and
treatment of canine angiostrongylosis
and treatment of canine lungworm
(Crenosoma vulpis). For the treatment
and prevention of flea infestation
(Ctenocephalides felis) in dogs, cats
and ferrets.
Disadvantages: No repellent action;
reduced efficacy after bathing/
swimming; occasional application site
reactions.
Comments: The only anti-flea and
heartworm prevention product
authorized for use in ferrets.
Fipronil (Frontline Spray® or
Frontline spot on®, Mérial Animal
Health Ltd; Fiprodog® or Fiprocat®,
Dechra Veterinary Products Ltd;
Fiprospot®, Ceva Animal Health Ltd;
Effipro spray® or Effipro spot on®,
Virbac Ltd; Fiproline, Francodex,
SAS & 4Fleas Fipronil, Alfamed SAS)
■
Advantages: All products kill adult fleas.
Effipro spot on® also effective for tick
infestation in dogs and cats, whereas
Spectrum of activity
Frequency of
use
Presentation Species
Affected by
weekly
bath/swim
Endoparasites
4 weeks
Ear mites
4 weeks
Sarcoptes
✓
4 weeks
Demodex
✓
Weekly
Ticks
✓
Use with
other
Flies
✓
Every 2 weeks
max.
Advantix
Advocate
Imidacloprid
Permethrin
Spot-on
9 weeks: C
7 weeks: D
✓A
✓
D only
4 weeks
C,D,F
✗
4 weeks
Spot-on
✓
(✓)
✗
Imidacloprid
Moxidectin
✓
✓A
(✓) D
✓
8 weeks
✓A
✓
D
8 weeks
Aludex
Biting lice
✗
4 weeks
Fleas
✓
4 weeks
4 weeks
Minimum age
for first use
✗
4 weeks
Active ingredient
(s)
✗
✗
Trade
name
✗
✓
D only
✓
✓
4 weeks
4 weeks
✓ A,L
✓A
✓
4 weeks
C,D,R
12 weeks
✓ A,L,O
✗
✓
✗
✗
Spot-on
4 weeks **
✓ A,O
✓
✗
Imidacloprid
D
8 weeks **
✓A
✓A
✓
✓
Advantage
Emulsion for
external use
only
C,D
14 weeks
✓ A,L,O
✓
✓
8 weeks: C,D
10 weeks: R
***
Tablet
D
8 weeks
2 days
✓A
✓A
✓
Amitraz
Spot-on
D
8 weeks **
✓A
✓A
Nitenpyram
Tablet
C,D
8 weeks **
2 days
7 weeks **
Fipronil
Amitraz
(s)-methoprene
C,D
8 weeks
D
Capstar
Spinosad
Spot-on
Spray
C,D
C,D
Spot-on
C,D
Mosquito
Sandfly
Stablefly
Certifect
Fipronil
Spot-on
C
✓
C,D
Comfortis
Fipronil
(s)-methoprene
Spot-on
Spray
✓
D only
Effipro
Fipronil
Spot-on
✓
D only
Frontline combo
Fipronil
Di: C,D,F
Av & Cv: D
Tc, At: C,D
Tv, Tl, Us: D
Frontline
4Fleas Fipronil
Fiprocat
Fiproline for cats
Spot-on
Di, Ac, Tc, Tv
Fiprospot
4 weeks
4 weeks
4 weeks
4 weeks
✗
✗
4 weeks
✗
✓
✓
✓
✓ A,O
✓ L,O
✓A
✓
8 weeks
✓A
✓
D
8 weeks**
8 weeks**
5–6 months
Spot-on
C
✓
4 weeks
Pyriprole
Lufenuron
Tablet
Milbemycin oxime.
D
✓
✗
Practic
D
C
Spot-on
Mosquito
Sandflies
Di, Tc
At: C only
Lufenuron
✓
Fipronil
✓
Fiprodog
Fipronil
Fiproline for dogs
✓
✓
D only
Program
Spot-on
✓ L,O
Puppies/
kittens taken
solid food *
Program Plus
Metaflumizone
D
ProMeris
Metaflumizone
Amitraz
✓
Tablet,
Suspension,
Injectable
ProMeris Duo
7 weeks**
6 weeks**
✓ A,L,O
D
C,D
Collar
Spot-on
Deltamethrin
Selamectin
Scalibor
Stronghold
C = cat, D = dog, F = ferret, R = Rabbit, A = Adulticidal, L = larvicidal, O = ovaricidal. Endoparsites (At = Ancylostoma tubaeforme, Av = Angiostongylus vasorum, Cv = Crenosoma vulpis, Di = Dirofilaria immitis, Tc = Toxocara cati/canis, Tl = Toxascaris leonine,
Tv = Trichuris vulpis, Us = Uncinaria stenocephala). * Can be used in pregnant bitches/queens, ** Can be used during pregnancy and lactation, *** Can be used in nursing bitches/queens
| 15
companion
How to pick your way through the jungle of
ectoparasite treatments for dogs and cats
■
■
Frontline spray®, Frontline spot on® and
Effipro spray® will additionally treat
canine and feline biting lice infestations.
Sprays can be used on puppies and
kittens older than two days.
Disadvantages: No repellent action; no
larvicidal/ovaricidal activities; reduced
efficacy after bathing/swimming;
occasional application site reactions;
spray is labour-intensive.
Comments: Do not use on rabbits (toxic).
Fipronil + (S)-methoprene
(Frontline Combo spot-on for dogs
and cats, Mérial Animal Health Ltd)
■
■
■
Advantages: Adulticidal, larvicidal and
ovaricidal activities against fleas;
effective against ticks and/or biting lice
in dogs and cats.
Disadvantages: No repellent action;
reduced efficacy after bathing/
swimming; occasional application site
reactions.
Comments: Do not use on rabbits (toxic).
Selamectin (Stronghold spot on®,
Pfizer Ltd)
■
Fipronil + (S)-methoprene +
amitraz (Certifect spot-on solution
for dogs, Mérial Animal Health Ltd)
■
■
■
16
Advantages: Adulticidal, larvicidal and
ovaricidal activities against fleas;
effective against ticks and/or biting lice
in dogs. Affects a wider range of tick
species then Frontline Combo,
increased speed of kill (starting at
2 hours and >90% at 24 hours) and a
longer duration of activity. Unlike other
products, dead and dying ticks fall off
the patient.
Disadvantages: Reduced efficacy after
bathing/swimming; occasional
application site reactions.
Comments: Do not use on rabbits or
cats (toxic). People with diabetes
mellitus or taking monoamine oxidase
inhibitors (MAOI) should take particular
care when handling the product.
| companion
■
■
Advantages: Effective against canine
Sarcoptes mites, feline/canine
Otodectes mites, canine/feline adult
intestinal roundworms, feline adult
intestinal hookworms, canine/feline
biting lice. Adulticidal, larvicidal and
ovicidal against fleas. Authorized for
the prevention of heartworm disease
(Dirofilaria immitis) in dogs/cats. Usable
for pregnant and lactating queens/
bitches.
Disadvantages: No repellent action;
reduced efficacy after bathing/
swimming; occasional application site
reactions reported.
Comment: Very wide spectrum
product.
Metaflumizone (ProMeris spot on
for cats®, Pfizer Ltd)
■
■
Advantages: Kills adult fleas on
contact.
Disadvantages: No repellent action;
reduced efficacy after bathing/
swimming; occasional application site
■
reactions (temporary oily appearance,
clumping/spiking of the coat, colour
change of fur). Slow acting (2–4 days).
Comment: Clients may not be happy
with oily coat appearance and possible
coat colour changes.
Metaflumizone + amitraz (ProMeris
Duo®, Pfizer Ltd)
■
■
■
Advantages: Kills adult fleas on
contact. Authorized for the treatment
and prevention of infestations by ticks,
treatment of canine demodicosis and
canine biting lice.
Disadvantages: No repellent action;
reduced efficacy after bathing/
swimming; side effects (sedation,
lethargy, CNS depression,
hyperglycaemia, bradycardia) can be
seen; strong odour of product (author´s
own experience).
Comments: People taking MAOIcontaining medication or who have
diabetes should take particular care
when handling the product. Potential
risk of dogs developing drug-induced
pemphigus foliaceus1.
Pyriprole (Prac-tic spot on solution
for dogs®, Novartis Animal Health
UK Ltd)
■
■
■
Advantages: Kills adult fleas within
24 hours; kills ticks within 48 hours.
Disadvantages: Not suitable for cats;
no repellent action; fur discoloration,
greasy appearance/clumping of the fur,
alopecia or pruritus may be observed
at the application site.
Comments: Do not use in rabbits.
Weekly immersion in water does not
affect efficacy against fleas/ticks, but
dogs should not be bathed/shampooed
from 48 hours before treatment and/or
within 24 hours after treatment.
Nitenpyram (Capstar tablet ,
Novartis Animal Health UK Ltd)
(Other products with the same active
ingredient are available)
®
■
■
■
Advantages: Kills 95–100% of adult
fleas within 6 hours; can be given to
animals at all stages of pregnancy or
lactation.
Disadvantages: No repellent action;
no larvicidal/ovaricidal activities
against fleas.
Comments: Not for use as sole anti-flea
therapy.
Spinosad (Comfortis chewable
tablet for dogs®, Elanco Companion
Animal Health)
■
■
Advantages: Rapid onset of action and
long duration (one month); therefore
almost complete prevention of
appearance of flea eggs in the
environment.
Disadvantages: Cannot be used in
cats. Cannot be used in dogs weighing
<3.9 kg as accurate dosing not
possible. Do not use in dogs with
pre-existing epilepsy. Product may
interact with other P-glycoprotein
substrates (e.g. digoxin, doxorubicin,
ciclosporin). Vomiting commonly
■
occurs in the first 48 hours after
dosing, but is transient, mild and does
not require symptomatic treatment.
Comments: Comfortis is authorized for
use in cats in the USA – so watch this
space!
Lufenuron + milbemycin (Program
Plus tablet for dogs®, Novartis
Animal Health UK Ltd)
■
Deltamethrin (Scalibor
Protectorband for dogs®, MSD
Animal Health)
■
■
■
Advantage: Control of infestations with
ticks and sandflies (Phlebotomus
perniciosus) for 5–6 months;
anti-feeding effect on adult mosquitoes
(Culex pipiens) for 6 months; can be
used during pregnancy and lactation.
Long acting!
Disadvantage: Collar maybe not
convenient for owner;strong smell; local
reactions may occur.
Comments: Remove collar before
swimming/bathing the dog because
deltamethrin is harmful to aquatic
organisms. Prevent dog from swimming
in water for the first 5 days of wearing
the collar.
Insect growth regulator
inhibitors
■
■
Advantages: Prevention of fleas;
prevention of heartworm disease
(L3 & L4 stages of Dirofilaria immitis);
treatment of adult stages of
gastrointestinal nematodes
(hookworms, roundworms and
whipworms) in dogs. It can be used
from 2 weeks of age.
Disadvantages: Not suitable for cats;
no effect against adult fleas; time lag of
60–90 days required to disrupt flea life
cycle; no repellent activity.
Comments: For heartworm-positive
dogs, adulticidal therapy is indicated
before administering Program Plus.
Acaricides
Products for tick control
■
■
Deltamethrin (Scalibor Protectorband
for dogs®, MSD Animal Health)
Fipronil (Frontline Spray® or Frontline
spot on ®, Mérial Animal Health Ltd;
Effipro spray ® or Effipro spot on®,
Virbac Ltd)
Lufenuron (Program tablet for
dogs®, Program suspension for
cats®, Program suspension for
injection for cats, Novartis Animal
Health UK Ltd)
■
■
■
Advantages: Inhibition of chitin
synthease results in flea eggs failing to
hatch. Can be given to pregnant
bitches and queens, lactating queens
and puppies/kittens taking solid food;
injection for cats lasts 6 months.
Disadvantages: No effect against
adult fleas; time lag of 60–90 days
required to disrupt flea life cycle; no
repellent activity.
Comments: Adulticide flea treatment
needed concurrently.
companion
| 17
How to pick your way through the jungle of
ectoparasite treatments for dogs and cats
■
■
■
■
■
■
■
Fipronil + (S)-methoprene (Frontline
Combo spot-on for dogs and cats,
Mérial Animal Health Ltd)
Fipronil + (S)-methoprene + amitraz
(Certifect spot-on solution for dogs,
Mérial Animal Health Ltd)
Imidacloprid + permethrin (Advantix
spot on for dogs®, Bayer plc)
Imidacloprid + moxidectin (Advocate
spot on®, Bayer plc)
Metaflumizone + amitraz (ProMeris
spot on for dogs®, Pfizer Ltd)
Pyriprole (Prac-tic spot on solution for
dogs®, Novartis Animal Health UK Ltd)
Selamectin (Stronghold spot on®,
Pfizer Ltd)
Products to treat sarcoptic mange
■
Amitraz (Aludex cutaneous solution for
dogs®, MSD Animal Health)
–
Advantages: Very effective.
–
Disadvantages: Not user-friendly
(see product insert for handling and
application directions); cannot be
used on Chihuahuas, pregnant or
lactating bitches or puppies
<3 months old; concurrent use with
■
■
other alpha-2 adrenoceptor
agonists not recommended. Known
side effects include skin irritation,
sedation, lethargy, CNS depression
and bradycardia; these usually
subside in 24 hours; if they are
severe or persistent, the patient
should be washed in warm water
and dried, and use of a reversal
agent (atipamezole 0.2 mg/kg i.m.)
considered.
–
Comments: Amitraz is an MAO
inhibitor and should not be used on
dogs or applied by anyone taking
other MAO inhibiting drugs. Care is
needed if the drug is being handled
by a diabetic owner or applied to a
diabetic patient, as they may
develop transient hyperglycaemia.
Do not use on cats or horses.
Selamectin (Stronghold spot on®,
Pfizer Ltd)
Imidacloprid + moxidectin (Advocate
spot on®, Bayer plc)
In-contact animals and the environment
should be treated concurrently.
Products to treat canine
demodicosis
■
■
■
Amitraz (Aludex cutaneous solution for
dogs®, MSD Animal Health)
–
Advantages, disadvantages and
comments as above for Amitraz in
treating sarcoptic mange.
Imidacloprid + moxidectin (Advocate
spot on®, Bayer plc)
Metaflumizone + amitraz (ProMeris
spot on for dogs®, Pfizer Ltd).
Products to treat cheyletiellosis
Currently there are no products authorized
for this use, although reports have shown
that fipronil- and selamectin-containing
products are effective. Alternative
treatments include weekly lime sulphur
18
| companion
dips, or weekly bathing with 1% selenium
sulphide shampoo over 3 consecutive
weeks. In-contact animals and the
environment should be treated
concurrently.
Products to treat trombiculidiasis
To the author’s knowledge there is currently
no authorized product available, but there
is evidence in the literature that fiproniland selamectin-containing products may
be effective.
Products to treat otocariosis
■
■
■
Imidacloprid + moxidectin (Advocate
spot on®, Bayer plc)
Selamectin (Stronghold spot on®,
Pfizer Ltd)
Tiabendazole (Auroto ear drop
solution®, Dechra Veterinary
Products Ltd)
In-contact animals and the environment
should be treated concurrently. ■
References and further reading available at the companion
area of BSAVA.com
Have we got
reviews for you
The review of immunomodulatory
drugs published in last
February’s issue was by some
distance the most downloaded
JSAP paper of 2011. The
authors, Nat Whitley and Michael
Day, explain the importance of a
review on this topic
has been considered mandatory to those in which it is
often not required or may even be detrimental.
Acknowledging both the difficulties encountered when
studying these diseases in a clinical setting and the
seductive logic of employing immunosuppressives, we
then took a frank look at the relatively small amount of
published evidence for current prescribing practices.
We concluded with an overview of future therapeutic
strategies that we hope will develop based on the
more refined therapies now used in human medicine.
We hope that readers find the review both a useful
resource when making treatment decisions and are
inspired to support or become involved in further
studies on management of these serious diseases.
A longer version of this review appears in the
January issue of JSAP.
Why commission review papers?
W
hen we were contacted by JSAP with an
idea for an immunology review, we were
allowed free rein to structure the review in
a manner that we hoped would offer
something to practitioners at all levels. We make no
apology for commencing with a ‘refresher’ section
summarising current thinking on the normal immune
response and development of autoimmunity – the field
is sufficiently complex and rapidly evolving that an
appreciation of recent advances in understanding is
highly desirable for those aiming to effectively manage
and refine their care for such patients. We then
introduced the principal immunosuppressive drugs
available to the practitioner – both ‘traditional’ and
emerging therapies, before focusing in depth on
specific diseases.
Five distinct conditions were chosen to illustrate
the spectrum of canine immune-mediated disease,
ranging from those where immunosuppressive therapy
Gerry Polton, one of JSAP ’s Commissioned Reviews
Editors, explains the philosophy behind the journal’s
strategy for review papers:
Although the primary function of JSAP is to provide
a vehicle for the presentation of the methods and
outcomes of scientific investigations, and thus to chart
progress in the field, it is also appropriate to seek to
provide learned articles defining the state of global
expert opinion and evaluating the evidence base for
this opinion – in the form of commissioned reviews.
The aim of a review paper is to collate evidence and
opinions, to summarise and explain inherent
controversies, and objectively to evaluate the pertinent
questions at the time. Times change, and as they do,
so do knowledge and opinion.
There are many reasons for commissioning a
review paper but, perhaps most importantly, a review
may be justified because the subject matter is
important to our readership. It is vital that JSAP
continues to be regarded as valuable by the members
of BSAVA. In commissioning reviews we therefore
strive to identify subject areas of interest and
importance to the practitioner in daily clinical small
animal practice.
If you are interested in writing a review paper, or
have any suggestions for topics that would add to
understanding of key areas of veterinary practice,
please contact [email protected] ■
companion
| 19
Congress · 11–15 APRIL 2012
Find orthopaedic
holy grail at Congress
Finding a way to repair the damaged cartilage surface
in patients with osteoarthritis has been described as
the Holy Grail of orthopaedic surgery. If that is so, then
the man who may take the role of Sir Galahad in that
adventure will be speaking to BSAVA members at their
annual Congress in Birmingham next April
J
imi Cook is the veterinary
researcher who heads a
multidisciplinary team at the
University of Missouri pioneering
new treatments for osteoarthritis in both
canine and human patients. A former
maths teacher and champion water-skier,
Dr Cook was a late arrival at veterinary
school but has made up for lost time in
investigating techniques for recreating fully
integrated and functional hyaline cartilage
and subchondral bone in damaged joints.
His presentation will describe those
techniques that are already here, some
that will be available very soon and others
that may loom over the horizon in the next
few years.
Osteochondral grafts
Osteochondral grafts taken either from the
patient’s opposite limb or occasionally from
another dog being euthanased for other
reasons are methods currently being used
by Cook and veterinary surgeons at other
leading referral centres. His own clinic has
performed more than 80 osteochondral
autografts to repair injured stifle joints,
generally in large and giant breeds.
The dogs have generally been in the
six to 18 months age range and have
severe pain and lameness in the affected
joint. With follow up periods of up to seven
years, the results to date have been
excellent with good integration of the graft
and improved function, he says.
Given that the tissue is usually the
patient’s own, it is no surprise that the
graft is accepted but this approach does
have a number of drawbacks – it is
technically demanding, can usually be
used only for small defects and there is a
danger of long term injury at the donor
site, he says. Allografts taken from a
donor dog can help repair much larger
defects and those in a wider range of
anatomical sites but the cells can
deteriorate during the processing phase
and there is the potential for both tissue
rejection and the transmission of other
disease conditions.
Synthetic grafts
There is also the possibility that synthetic
materials could replace the canine tissue
used in those grafts. The basic
technology for two potential methods is
already produced commercially and is
currently undergoing clinical trials in the
US and Canada.
Dr Cook is one of the patent holders for
one of these systems, known as canine
unicompartmental elbow (CUE)
arthroplasty. This is used to treat the
common problem of damage to the medial
compartment of the elbow – the worn
cartilage is replaced by a synthetic plug on
the ulna and a metal implant on the medial
aspect of the humerus. Dr Cook says that
the early results from initial studies on both
methods are very encouraging.
However, any metal and plastic will be
at its best at the moment it is implanted
and will start to deteriorate from that day
onwards, says Cook. The ideal solution
would be to create a perfect replica of the
original joint using materials that will adapt
and strengthen as the limb is used.
Leading the field
Cook’s laboratory is leading the field in the
development of cell-based and tissue
engineering options for repairing injured
joints. His team’s approach, which has
been successfully tested in a rabbit model,
involves moulding a scaffold combining a
synthetic material, polycaprolactone and a
20
| companion
When it’s a matter of
life and death
natural component of bone, hydroxyapatite.
They then culture the patient’s own stem
cells with a specific cytokine which will
transform the undifferentiated cells into the
healthy cartilage used to cover the surface
of the joint implant.
Dr Cook says the research is opening
up exciting possibilities for treating both
dogs and the thousands of human
patients that would currently be
candidates for total hip or knee
replacement surgery. But because of the
regulatory authorities’ concerns over the
potential risks of using synthetic growth
factors on human tissues and the need for
long follow up periods in clinical trials, it
may be 10 or 20 years before the
technique becomes widely available.
In the meantime, he points out that
there are alternatives to palliative medical
treatment in dogs with painful osteoarthritis;
but it is important that the long term effects
of any novel therapy are examined
carefully. “Biological options for the
treatment of cartilage defects are available
now and should be a consideration for
appropriate cases. But it is important that
we develop optimal treatment algorithms
based on evidence from long term cohort
studies,” he says. ■
JIMI AT CONGRESS
■■
■■
■■
■■
■■
The meniscus: what do we do with it? –
Thursday AM
EBM approach to developing the
algorithm for the treatment of shoulder
instability – Thursday PM
Clinically relevant biological strategies
for cartilage resurfacing in dogs –
Saturday AM
Advanced arthroscopic techniques–
Saturday AM
Postoperative nursing care of orthopaedic
and trauma patients: how to best help the
patient, client and vet – Saturday PM
See the full Vet Programme online at
www.bsava.com/congress
A highly skilled veterinary nurse is an invaluable
member of the clinical team, and with speakers like
Charlotte Donohoe at Congress, VN delegates will be
returning to the practice with the most up-to-date and
practical skills
D
ealing with a medical or surgical
emergency is probably the
biggest test of a VN’s knowledge
and training. These may happen
every week in a specialist centre but for
most young nurses working in a first
opinion practice, they may be an
infrequent occurrence and one that is
bound to create a twinge of anxiety.
So guidance on exactly what to do in
these high pressure situations will be
given in one of the nursing streams at
BSAVA Congress in Birmingham next year
by a Canadian veterinary nurse, Charlotte
Donohoe. She has spent the past 13
years working in the critical care unit of
the small animal hospital at the University
of Guelph in Ontario, including the past
six years as the coordinator for
emergency referrals.
Charlotte has earned an impressive
reputation as an inspiring speaker, and
her presentation on triage skills for the VN
will provide a useful checklist for what to
do, and what not to do, when a client calls
in a panic because they fear for their pet’s
life. Charlotte will set out a plan for
assessing the pet’s condition and
administering appropriate emergency
care, as well as supporting the client and
the entire clinical team.
“You must remember not to get
distracted by the emotional upset of the
client, while still being sympathetic. You
have to focus on what is most important
with regard to the immediate health and
safety of the animal,” Charlotte explains.
Yet even for a highly experienced
emergency room technician, it is important
not to rely completely on standard
protocols. “If there is one take-home
message that I would like my audience to
remember, it is that in these situations they
should never take anything for granted.
Some animals cope much more effectively
with severe illness than others and so they
may look much healthier than they actually
are. So it is vital that when assessing the
animal on its arrival, the technician is
very thorough and makes full use of their
powers of observation.” ■
CHARLOTTE AT CONGRESS
■■
■■
■■
■■
■■
Triage skills for the VN – Thursday AM
Thermal burns: management of the burn
patient – Thursday AM
Fluid therapy for the VN: evaluation and
monitoring – Friday AM
GDV: anatomy and physiology – why it
happens? – Friday PM
GDV: emergency management –
Friday PM
See the full Nurse Programme online at
www.bsava.com/congress
companion
| 21
Congress · 11–15 APRIL 2012
Practical knowledge for
practice management
The speakers for BSAVA’s business programme
have been chosen because they have real, practical
knowledge and experiences to share. So your time
in the Management Marquee will be very well spent
– and your practice will be better off for it too. Here is
a little detail about the talks taking place on the
Thursday and Friday of Congress…
An overview of key findings
from BrAkke – Dave Nicol
The BRAKKE study is a large scale view of
what is happening in the US vet market.
The session will look at the key messages
from the results and examine why owners
do not access vet care and what can be
done about it, and what this means for you.
Data from other countries will add to the
richness of the session.
What makes a successful
veterinary practice?
– Mark Beaney
This session will look at the “must know”
rules of the veterinary business. Why do
some people do well and end up with a
great lifestyle and a great clinical practice
and others struggle to make ends meet?
The key differences are all in the way they
do business and how they manage the
numbers. This is a must attend session.
The role of Net Promoter Score
– Alison Lambert
The Net Promoter Score is a statistical
measure of overall client satisfaction. It
allows you to understand how your clients
feel about your practice’s service, and
track any improvements or declines. More
importantly, you can then act to address
any issues quickly before turnover,
profitability and growth are affected.
Managing people to get good
results – Shawn McVey
Shawn will take you through a no-holdsbarred approach to getting the best from
22
| companion
people – what to do and how to do it! The
session promises to be a memorable one.
So what if I make no profit; I still
have cash, don’t I? – Mark Beaney
The role of cash and profit – in the current
climate cash is king. This session will take
you through how to manage your profit (or
get some if you haven’t!) and make better
use of your cash.
How to deal with things when they
don’t go to plan – Shawn McVey
Improve not only your life but the running of
the practice with this simple and practical
process – the After Action Review.
What pet owners want from a vet
– Alison Lambert
Find out how clients choose their practice
through a range of rational and emotional
factors, including; locality and
convenience, recommendation, and from
local key opinion leaders.
Performance management
– Dave Nicol
This session will give you a route map and
guide you through what to do and how to
make performance management work.
Growth in the face of local
competition – Marwan Tarazi
NuVet launched three years ago from a
standing start – with no history in the
Peterborough area and no relationships
with local pet owners. Now they have
100 new client registrations every month.
Find out how they did it.
Owning a practice and making it
work, a VN perspective
– Tracey Mayne
The journey to practice ownership by a
nurse – this session will look at the highs
and lows of a VN owner. A brilliant,
personal view of what is possible.
Sites and customers: the
corporate view – Peter Watson
This is a ‘through the key hole’ view of what
Vets4Pets do when they open up a site. A
unique perspective and one not to miss.
Communication: how to make it
all work – Shawn McVey
Change at work begins with authentic,
honest conversations. To stay competitive,
we must become black-belt
conversationalists.
What really happens in the
consult room – Alison Lambert
Paying attention to seven key steps during
a client consultation will improve both
practice efficiency and client satisfaction.
reprogramming pets and vets
– Margit Bossard
If you would like to improve the behaviour
of your staff, your colleagues and your
clients, encourage and reward them –
recognise stress and diminish the factors
that are causing stress.
How to motivate your staff
– Shawn McVey
Staff motivation is one of the hardest
challenges for any business owner. This
session will give top tips and inspiration to
make it happen.
Any delegate can attend these lectures,
though priority will be given to those who
are attending on a Practice Manager’s ticket
– allowing attendance at these lectures
on Thursday and Friday, plus access to the
exhibition on Saturday and Sunday. Register
now at www.bsava.com/congress.
Skin lumps
and bumps
7 February
An entirely
practical approach
to managing skin
tumours of the
dog and cat
SPEAKER
Iain Grant
VENUE
The Bridge, Wetherby
FEES
The ear,
the nose,
the throat
20 March
Tackling tricky problems
and providing
practical solutions
SPEAKER
Davina Anderson
VENUE
Chilworth Manor, Southampton
FEES
BSAVA Member: £227.00
Non BSAVA Member: £340.00
BSAVA Member: £227.00
Non BSAVA Member: £340.00
Introduction to
practical cytology
Linked
webinars
13 March
Many of our courses now include
the opportunity to attend a free
post-event webinar when you book
your place on the course – giving
you even more value for money and
even more practical knowledge.
A very practical day with
individual use of high
quality microscopes
*Available where you see this symbol.
SPEAKER
Michael Day
VENUE
BSAVA Headquarters,
Gloucester
FEES
BSAVA Member: £338.00
Non BSAVA Member:
£507.00
Learn
@Lunch
webinars
A new member benefit for 2012 –
from May members will be able to login
to lunchtime webinars to top-up their
skills free of charge.
Visit www.bsava.com/webinars
for more information.
For more information or to book your course
www.bsava.com
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On the border
of change
New year means new
regulations – as the UK loses
its derogation under EU rules.
This is what you need to know
about pet travel and the
implications for your clients
O
n 31 December 2011 the UK lost its
derogations under EU Regulation 998/2003
relating to the non-commercial movement
of pet animals between EU member states.
This will bring the UK into line with other member
states and make it easier to bring pet animals into
the UK. Until now the UK, as well as Ireland, Sweden
and Malta have been able to apply more stringent
controls to protect against the entry of rabies. These
countries, plus Finland, have also had a second
derogation to apply additional entry conditions to
protect against the entry of tick-borne diseases
(e.g. Mediterranean spotted fever) and the
tapeworm, Echinococcus multilocularis.
New regulations
From 1 January 2012 the rules for bringing
pet dogs, cats, and ferrets into the UK
changed. All pets entering the UK will still
need to be microchipped and vaccinated
against rabies. However under the new
rules pet dogs, cats and ferrets from
other EU Member States, and listed
approved countries, will not need a
blood test and can enter the UK 21
days after their rabies vaccination
(rather than having to wait 6
months and provide proof of a
protective titre).
Pets entering the UK from
non-approved countries will
still require a blood test,
which should be taken at
least 30 days after vaccination
and 3 months before entry
into the UK. Providing pets
meet these requirements they
will no longer be required to
undergo quarantine on entry.
24
| companion
EU and approved third countries
Non-approved countries
Microchip
Yes
Yes
Rabies vaccination
Yes
Yes
Documentation *
Yes
Yes
Blood test
No
Yes. At least 30 days post vaccination
Length of waiting period before entry
21 days after vaccination against
rabies
3 months after blood sample date
Tick Treatment
No
No
Tapeworm treatment **
1–5 days before entry
1–5 days before entry
* EU Pet Passport or official veterinary certificate from third country. ** Dogs only
The up-to-date list of non-EU countries and
specific requirements relating to these countries can
be found at: www.defra.gov.uk/wildlife-pets/pets/
travel/pets/countries/noneu-countries/.
Pets travelling from the UK to EU countries will also
need to be microchipped and vaccinated against
rabies at least 21 days before travelling. The number of
pets (dogs, cats and ferrets) that can be moved
between EU Member States, including into and out of
the UK, is limited to five per person. Anyone moving
more animals, for example to take part in a show or
sporting event will require a specific health certificate
issued by the Animal Health and Veterinary
Laboratories Agency animalhealth.defra.gov.uk/
imports-exports/index.htm. Countries outside the
EU will continue to set their own entry requirements. It
is important to note that these changes may have an
effect on the entry requirements to other countries, for
example from From 1 January 2012, cats and dogs
from the UK, will be required to have a rabies
vaccination and rabies blood test prior to entry into
Australia www.daff.gov.au/aqis/cat-dogs.
Client information
The regulations are primarily designed to promote free
movement throughout the European Union and protect
human health, based on a risk assessment for the
spread of diseases of zoonotic importance; they are
not concerned with the protection of individual
animals. BSAVA have prepared a poster to help you
inform owners of the health and welfare implications of
taking their pets abroad www.bsava.com/Advice/
PetTravel/tabid/172/Default.aspx.
Clients will also need advice on the preventive
measures required to protect their animals against a
number of parasites and diseases which are not, or
only rarely, encountered in the UK. This advice will
need to be tailored to the individual animal and
particular itinerary.
Disease risks abroad
Echinococcos multilocularis – is a taeniid tapeworm
endemic in much of Europe, from central France
eastwards. Foxes are the main definitive hosts and
voles and other small rodents act as intermediate
hosts. Dogs are easily infected and although the adult
parasite produces no clinical signs in dogs it can
cause a potentially fatal condition in humans (alveolar
echinococcosis). The microscopic eggs are infective
immediately. Infection is uncommon but not impossible
in cats.
In endemic areas it is recommended that dogs
which have access to rodents are wormed monthly
with praziquantal. It is also important to advise clients
that the eggs can also be found in the dog’s coat
especially if it becomes contaminated with fox faeces.
Dogs are required to be treated E. multilocularis before
entry into the UK.
Vector borne diseases
Tick borne diseases
Although the requirement to treat pets for ticks before
re-entry into the UK has been removed the need to
treat them before travelling abroad has not. While both
ticks and tick borne diseases such as Lyme disease
(Borrelia burgdorferi) are present in the UK there are
also species of tick (Rhipicephalus sanguineus) and
diseases (e.g. Erlichia canis, Babesia canis canis and
Hepatozoon spp) which are not. While the majority of
ticks are found in pasture and woodland it should be
remembered that R. sanguineus can be found in
domestic environments such as homes and kennels.
Acaracides should be applied before travel,
animals should be checked regularly and visible ticks
removed. It should be remembered that frequent water
exposure may reduce the efficacy of the acaricidal
product and products should be reapplied in line with
the manufacturer’s instructions.
companion | 25
On the border of change
Other vector borne diseases
Leishmaniasis is an infectious and
potentially fatal disease caused by a
protozoan parasite common in
Mediterranean coastal areas and
transmitted by phlebotomine sand flies.
Despite the name, which relates to their
brownish colour, the flies are found in
woodlands and crevices in old buildings.
The sand flies are active from May to
October and feed mainly at dusk and
dawn. Prevention involves avoiding the
sand flies and the use of insect repellents
such as those containing synthetic
pyrethroids (do not use in cats) although
repellents alone cannot be relied upon to
prevent disease. A vaccine has recently
been launched in Europe but is not yet
available in the UK.
Dirofilaria immitis (heartworm) is a
nematode worm endemic in Mediterranean
areas. Dogs are the primary definitive host
however the cat is a susceptible if not
ideal host. Microfilariae are spread by
blood sucking mosquitoes during feeding
and the larvae migrate to the pulmonary
artery and adjacent areas where they
develop into adult worms. Many
mosquitoes are capable of transmitting the
parasite including species present in the
UK. While the synthetic pyrethroids have
some repellent effect on mosquitoes these
should not be relied upon and preventive
treatments such as Milbemycin or
Selamectin should be given throughout
the mosquito season starting 1 month
before exposure.
Rabies
Rabies in Europe is predominately sylvatic
rabies, with wildlife species, especially the
Red Fox (Vulpes vulpes), accounting for
approximately 80% of all rabies cases.
While many Western European Countries
have successfully controlled rabies in
wildlife through the use of oral vaccination
programs it should be remembered that
sporadic cases do still occur, usually in
illegally imported animals. While travelling
pets will be protected by vaccination it is
important for clients to realise that humans
will not be and to get immediate treatment
for any bite wound.
It is also important to stress to clients
the importance of not deciding to rescue
strays of unknown health status as this
risks introducing a number of diseases into
the UK.
Implications for disease risks
in UK
It is likely that the changes in the
regulations will increase the number of
pets travelling between the UK and
Europe. This coupled with the loss of
pre-entry tick treatment means that we
are likely to see more of the “exotic”
diseases mentioned above. While the risk
of rabies entering the UK is still considered
to be very low, and most likely to be
brought in by an illegally imported animal,
it would be wrong to be complacent and
we must remain vigilant. Rabies is a
notifiable disease and any suspect case
should be reported immediately to your
nearest Animal Health Office
animalhealth.defra.gov.uk/about/
contact-us/index.htm.The suspected
animal should be kept isolated and
restrained along with any other animals
that have had contact with the suspect
case. A veterinary officer will normally
come to the practice immediately and will
manage the investigation. n
See the How To on p14 of this issue of
companion.
Find out more
Further information is available on the BSAVA website in the Pet travel section under the
Advice link. Other sources of information include:
■■
■■
■■
■■
Defra travel regulations
www.defra.gov.uk/publications/2011/06/30/pb13582-bringing-pets-into-uk/
BVA – Animal Welfare Foundation leaflet on taking your pets abroad
www.bva-awf.org.uk/resources/leaflets/BVA_AWF_Taking_your_pets_abroad_1008.pdf
ESCCAP – Parasite maps
www.esccapuk.org.uk/maps/by_parasite.html
Health Protection Agency advice on Rabies
www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Rabies/
|
26 companion
STOP PRESS
Movement of pets
between Republic of
Ireland and the UK
The following
information became
available just before
going to press with
this article…
U
nder the EU pet movement
system, all pet dogs, cats
and ferrets moving between
EU Member States must
meet the same animal health rules.
From 1 January 2012 the requirement
is that all pets travelling from the
Republic of Ireland to the UK should
be microchipped, vaccinated against
rabies and accompanied by a pet
passport.
As both the Republic of Ireland and
the UK have had no indigenous rabies
for many decades, compliance checks
on pets travelling between the two
countries will not be applied. Pet
owners travelling with their pets should
therefore not experience any change
on the ground from the 1 January.
www.defra.gov.uk/wildlife-pets/
pets/travel/pets
■■ www.agriculture.gov.ie/pets/
introduction
■■
WSAVA endorses
AAHA practice
accreditation scheme
WSAVA has announced its
support for AAHA’s accreditation
programme and is working to
raise awareness of the help that
similar programmes can offer to
veterinary professionals
T
he American Animal Hospital Association’s
accreditation programme, currently unique to
North America, accredits practices based on
their adherence to standards covering, for
instance, the physical environment they provide, the
type of equipment they offer and the clinical standards
they adhere to. Specific standards have been
developed for a range of practice settings including a
general clinic, an emergency clinic and a specialty
practice. Practices have to submit to a detailed
inspection and those completing it successfully are
awarded a certificate of accreditation. Re-inspections
are arranged based on the accreditation on a periodic
schedule.
Debbie Gadomski, RVT, National Field Operations
Manager at the AAHA comments: “Each year we
receive many calls from veterinarians around the world
who want to become AAHA accredited in order to
optimise their hospital procedures and patient care.
While we can’t expand our own programme beyond
North America, we can help other associations
develop accreditation programmes which are
appropriate to their needs so this is where we are now
focusing our efforts with the support of the WSAVA.
Earlier this year, for instance, we had the privilege of
working with a group of veterinarians and educators
from the Veterinary Practitioner Association of Thailand
(VPAT), including Siraya Chunekamrai, DVM, PhD, a
member of the WSAVA’s Executive Board, to explore
the best way of developing accreditation schemes for
companion
| 27
WSAVA news
Thailand and other countries in South East Asia.”
WSAVA President Jolle Kirpensteijn adds: “The
promotion of best practice guidelines for treating
conditions with global relevance is one of the WSAVA’s
key focus areas, so we share a common vision with the
AAHA in this respect. Its work complements our
approach to diagnostic and therapeutic guideline
setting and we’re delighted that they are receiving
such a strong level of interest globally in their practice
standards. We are great supporters of the AAHA’s
work and look forward to working with the organisation
collaboratively during 2012 and beyond.” ■
wsaVa enDOrses aCVD GuIDeLInes
Following review by our Scientific Advisory Committee
(SAC) the WSAVA Scientific has endorsed peer-reviewed
guidelines on the treatment of atopic dermatitis in dogs
published by the International Committee for Allergic
Disease of Animals (ICADA). The Guidelines, aimed at
educating general practitioners on the treatment of this
common allergic skin disease, can be downloaded in
English at www.wsava.org and translations into more than
15 languages are also being uploaded. WSAVA Secretary
Walt Ingwersen commented: “These Guidelines provide
valuable clinical information which SAC believes to be
relevant to small animal veterinary medicine globally.”
An active year for the WSAVA’s
One Health Committee
Michael Day
reports on a busy
2011 as the OHC
progresses towards
its goals
2
011 was a busy year for the new WSAVA One
Health Committee (OHC) as we work towards
our mission of ‘ensuring the prominence of the
small companion animal–human interface in
the global One Health agenda.’ We’ve reported
previously our participation in the first international
One Health Conference in Melbourne, Australia, an
achievement built on with the signing of a formal
memorandum of agreement with the OIE in May,
making WSAVA the official voice for small companion
animals in this global forum. We followed this in
September with Sarah Cleaveland, Professor of
Comparative Epidemiology at the University of
Glasgow, representing the OHC at the OIE-World
Health Organization conference on rabies eradication
in Seoul, Korea.
Of course One Health was also prominent at the
WSAVA Congress in Korea in October and the first
28
| companion
WSAVA Global One Health Award was presented to
the OIE and was accepted on behalf of the
organisation by Dr Tomoko Ishibashi, Deputy Director
of the OIE in the Asia-Pacific Region.
In addition to attending these key events, the OHC
has published two scientific papers in the open access
journal Parasites and Vectors during the year and is
currently working on a series of further review articles.
We have identified global rabies eradication as a focus
for attention and will announce exciting new initiatives
to support ongoing programmes in this area next year.
Just recently on 30 November and 1 December,
we attended a meeting at the Centers for Disease
Control and Prevention (CDC) in Atlanta, Georgia,
USA. During the session, we were privileged to be
able to visit the Emergency Operations Center at CDC,
the operational hub for the co-ordination of global
infectious disease outbreaks. We also attended a
lecture on the new One Health programme emerging
from the US Department of Agriculture and met with
numerous CDC Subject Matter Experts to discuss
topics as diverse as issues surrounding the global
transport of exotic animal pets and the role of dog
walking in tackling human obesity.
All in all, it was a busy and productive first year for
the OHC with much more planned to help us move
towards our goal in 2012. ■
Professor Michael Day
WSAVA Foundation –
off to a flying start!
In a
previous
issue we
reported
on the new
WSAVA Foundation
– here’s an update
on progress
M
omentum is building with our
recently launched WSAVA
Foundation thanks to the generosity
of the Swiss Small Animal Medicine
Association, which has donated 30,000 Swiss
Francs (£20,000) for initial projects. A new
website for the Foundation has also been
launched at www.wsavafoundation.org.
WSAVA President Jolle Kirpensteijn has also
set an example by making a personal
donation of $1,000. He says: “The WSAVA
Foundation is one of our most important
initiatives. It will ensure we can deliver our
mission on a global scale and provides a
framework for individuals and companies
to support our work.”
Dr Larry Dee, WSAVA Foundation
President, commented: “Through the
WSAVA Foundation we aim to deliver on
an ambitious vision to improve global
companion animal care. We’re indebted
both to Jolle and to Christophe Amberger
and his team in Switzerland for their
significant donation and would be most
grateful for further donations, whether
from member associations, industry or
other partners, to support the
Foundation’s work.” ■
A record year for new members!
Thirteen new member
associations joined WSAVA in
2011. WSAVA now represents
around 180,000 vets around
the world
W
SAVA is delighted to announce that 13
new member associations joined the
Association during 2011. Between them,
they represent around 65,000 new
companion animal veterinarians, bringing the total
number represented globally by WSAVA to around
180,000. This is a great achievement and reflects the
hard work carried out by our existing members to
demonstrate the value and effectiveness of the
organisation in enhancing the clinical care of
companion animals globally.
Our new members are…
Full members
■■
■■
■■
■■
■■
The American Veterinary Medical Association
The Canadian Veterinary Medical Association
The Society of Japanese Companion Animal Practitioners
The Japanese Board of Veterinary Practitioners
The St Petersburg Veterinary Society
Associate members
■■
■■
■■
■■
■■
The Albanian Chamber of Veterinary Surgeons
Ghana Private Veterinary Medical Association
The Society of Companion Animal Practitioners of Sri Lanka
The Mongolian Veterinary Medical Association
The Vietnam Small Animal Veterinary Association
Affiliate members
■■
■■
■■
The Veterinary Society of Surgical Oncology
The Western Veterinary Conference
The World Aquatic Veterinary Medical Association
We’d like to extend a big welcome to all our new
member associations. We look forward to working with
you in 2012 and beyond! ■
companion
| 29
the companion interview
Richard
Saunders
BSc(Hons) BVSc MSB CBiol
DZooMed(Mammalian) MRCVS
Richard grew up in East Sussex and went to school in Battle. His father was a
carpenter and his mother a secretary. Richard qualified from Liverpool University in
1994, obtained his Certificate in Zoological Medicine in 2001 and his Diploma in
Zoological Medicine in 2010. Having previously worked in small animal, avian and
exotic first opinion practice, Richard has just completed the RWAF Senior Clinical
Training Scholarship in Zoo and Rabbit Medicine at Bristol Zoo and Langford,
University of Bristol. Richard has lectured and written articles on rabbits and exotics,
co‑authored Notes on Rabbit Internal Medicine and has a particular interest in
chinchillas, rabbits and birds of prey. He is married to Sian, who is a vet working for
the PDSA, and they have two children, Taryn and Dylan. Richard is a valued
speaker on BSAVA courses and is a JSAP Associate Editor.
Q
Did you have any vets in your
family?
A
No vets, but the rest of my family on
my father’s side were farmers
(livestock and arable).
What made you want to be a vet?
I was particularly inspired by Gerald Durrell
– I loved his books and it made me want to
see and treat exotic, wild and zoo species.
How did you decide to take the
veterinary career path you chose?
I have always wanted to have a variety of
patients, wanting to treat all species of
animal, not just cats and dogs – everything
30
| companion
I have done has been aimed at increasing
the range of different animals I am lucky
enough to see.
What jobs have you done?
I have worked in general small animal
practice, with British wildlife at the RSPCA
Norfolk Wildlife Hospital, in referral avian
and exotic practice, and I recently
completed a residency in zoo and rabbit
medicine at Bristol, where I am currently
working part time for Bristol Zoo Gardens,
and part time as the veterinary advisor for
the Rabbit Welfare Association and Fund.
What is your involvement in BSAVA?
I have attended BSAVA CPD since my first
time at Congress in my fourth year at
University, and bought each new exotic
manual as it came out. Recently I have
been lucky enough to speak at BSAVA
regional courses, and at Congress. I am an
Associate Editor (exotics) for JSAP.
What does your role with JSAP involve?
My role involves reading exotic animal
papers submitted to JSAP for peer review,
and assigning the most appropriate
reviewers to them from within this very
broad field.
Why is the peer review process so
important in journal publishing?
Peer review is vital to journal publishing.
…Practitioners see
a huge caseload
compared to academics,
and have a lot to offer
journal publishing…
If you had not been a vet, what other
career might you have chosen?
Crime writer or forensic pathologist.
Or both.
Who would you invite to your dream
dinner party?
Bill Bryson, the late Douglas Adams, Joss
Whedon, Eddie Izzard, Lucy Mangan and
Sandi Toksvig.
Independent, blinded peer review
carried out by at least two suitable
people allows these papers to be
questioned and investigated by enquiring
minds. It is all too easy for the author(s) to
get too close to a topic, and to have not
asked themselves awkward questions
about it. That questioning process helps
to identify any potential flaws, and allows
the author(s) to look deeper at their work,
and produce a more robust and
thoughtful paper.
Do you think we can do more to
encourage practitioners to submit
papers to peer reviewed journals?
I think practitioners are disinclined to
submit papers for publication for many
reasons. Partly because they do not feel
they have anything to submit, which is a
shame, and not true, as so many exotic
animal cases out there go unreported.
Often they also lack easy access to
literature searching of more than just
abstracts, in order to read around a
topic. And finally, because they think it
is a lot of work.
I feel that we all need encouraging on
the first point: many exotic case series
reports are sitting in folders and on
computers just waiting to be written up.
I would strongly encourage practitioners to
find out if they have the first cases of a
condition, or whether they have noticed
something out there which needs
investigation. Practitioners see a huge
caseload compared to academics, and
have a lot to offer journal publishing.
I would like to see easier access to
electronic journal searching, from
practitioners’ alma maters or the RCVS,
with a wide range of journals and
complete paper access, for an
appropriate and reasonable cost. There
is not much anyone can do about the
last point. Electronic submissions have
made this easier than it once was, but
getting all the details together and writing
up a paper takes time.
What is the greatest challenge faced
by someone reviewing papers for
journals?
I think the biggest challenge is when
you read a paper which contains
useful information, and you know it will
help others, but realising that by itself it
just isn’t enough – for instance,
information is lacking, or assumptions or
speculations are made that are just not
supported by the data. This is often
because the data is collected
retrospectively, and sometimes it will never
have been possible to collect. It’s
frustrating for the reviewer, and obviously
for the author, to know that they have news
of a condition or technique or
epidemiological factor that is useful but
just not quite significant enough, with the
information available, to publish.
Which living person do you most admire,
and why?
It’s a cliché, but David Attenborough. He
has probably done more to inspire people
about the importance of the natural world
than anyone alive.
What single thing would improve the
quality of your life?
Teleportation.
What is the most important lesson life
has taught you?
“Never ascribe to malice that which can
adequately be explained by
incompetence.” — Napoleon Bonaparte
Is there a song that will always get you
on the dance floor?
Love Cats by The Cure.
If you were given unlimited political
power, what would you do?
Start treating global warming as a serious
problem that affects the entire world, and
make all world governments start
developing technical solutions to stop
dependency on our finite reserves of
fossil fuels before the human cost is too
great. Use green technological
development as an economic force for
good, employing people throughout the
world. Fund it all with a tax on the
essentially pointless movement of money
from one place to another. ■
companion
| 31
Improving the health of the nation’s pets
Hormones and
hyperthyroidism
Tim Williams is currently receiving Petsavers
Clinical Research Project funding to examine
the role of phosphate regulatory hormones in
the development of renal azotaemia in cats
treated for hyperthyroidism. Tim is joined by
Jonathan Elliott and Harriet Syme of the RVC to
look at the preliminary results
H
yperthyroidism is an increasingly common
condition of old cats with a reported annual
incidence of 6% in four London based first
opinion practices.1 Chronic kidney disease
(CKD) is also a common condition of geriatric cats,
reported to be present in around 15% of cats aged 15
years or older.2 As approximately 30% of hyperthyroid
cats have concurrent CKD, it has been postulated that
hyperthyroidism might cause damage to the kidney
through a number of mechanisms.
Hyperthyroidism causes derangements in
phosphate metabolism, such as hyperphosphataemia
and hyperparathyroidism, which are similar to those
observed in feline CKD.3 Hyperphosphataemia and
hyperparathyroidism are also associated with
progression of CKD in cats; therefore, hyperthyroidismassociated hyperphosphataemia and hyperparathyroidism might also lead to renal damage and the
progression of pre-existing CKD.
In addition, hyperparathyroidism is associated with
bone demineralisation and bone pain in human CKD
patients. It is possible that the hyperparathyroidism
associated with feline hyperthyroidism will contribute to
morbidity, reduced quality of life and thus reduced
survival time in hyperthyroid cats.
Gathering evidence
For the past 20 years, our group has run free geriatric
cat clinics in the PDSA Bow and the Beaumont
Sainsbury Animals’ Hospital in Camden, where we
have collected samples from over 400 hyperthyroid
cats, many of which were managed and followed for
many years. This has given us a large amount of
longitudinal data, enabling us to determine which
hyperthyroid cats develop CKD.
Using residual stored blood samples from these
cats we plan to investigate the changes in phosphate
metabolism that occur in hyperthyroidism by measuring
the plasma concentrations of the three regulatory
hormones of calcium and phosphate; parathyroid
hormone (PTH), calcitriol and fibroblast growth factor-23
(FGF23). We will then determine if there is a correlation
between derangements in phosphate metabolism, such
as hyperparathyroidism, and the presence of CKD and
survival time in hyperthyroid cats.
If these associations are shown to exist, this could
indicate that interventions to reduce plasma phosphate
and PTH concentrations, such as dietary phosphate
restriction, might be beneficial to hyperthyroid cats.
Gathering evidence
Preliminary results suggest that patterns of PTH and
FGF23 secretion in hyperthyroid cats are different to
those seen in human patients with hyperthyroidism
(Graves’ disease). Human hyperthyroid patients are
reported to have suppressed serum PTH
concentrations and elevated serum FGF23
concentrations,4 whereas cats with hyperthyroidism
appear to have elevated plasma PTH concentrations3
and suppressed plasma FGF23 concentrations.5
Why phosphate metabolism in hyperthyroid cats
differs so greatly from that of hyperthyroid humans is
an intriguing question. Differences in renal function
between geriatric hyperthyroid cats and (generally
younger) human hyperthyroid patients might be one
potential explanation, however further analysis of
plasma ionised calcium and calcitriol concentrations
will be required before the physiological relationships
between hyperthyroidism and phosphate metabolism
in cats can be fully explored. ■
References available at the companion area of BSAVA.com
32
| companion
Focus on...
BSAVA Midland Region
Midlands go interactive
The Midlands have been our first region to trial the
use of interactive equipment called TurningPoint in
their meetings; you might have used it at BSAVA
Congress in the past. It was deemed a big success
at a November talk called Practical Reading of
Chest Radiographs with the speaker Richard Ewers.
Richard told BSAVA that he felt it worked really
well for speaker and delegate alike, saying; “Using
TurningPoint definitely increased delegate
engagement and interest whilst giving them instant
feedback on how well they have understood the
material as well as seeing how they compare to the
others – in private”.
The next interactive meeting in the Midlands will
be on Tuesday 17 January – Managing Seizures
with Mike Targett in Derby (details below).
BSAVA Midland Region is always keen to hear
what you want in your region so please let us know.
Email [email protected] with your
suggestions on topics and speakers – and to find
out about getting involved and helping to design
the delivery of CPD in your area.
Who’s who on Midland Committee
■
■
■
■
■
Chair – Mike Davies
Secretary – Helen Ozelton
Treasurer – David Godfrey
Petsavers Rep – Derek Attride
Committee Members – Carol Dickson and
Rachael Mort
OCTOBER – Tuesday 16
Courses in 2012
JANUARY – Tuesday 17
Managing seizures (interactive)
■
■
■
Evening Meeting 7.00 for 7.30–9.30pm
Mike Targett MA VetMB PhD DipECVN MRCVS
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby
FEBRUARY – Tuesday 21
Otitis externa
■
■
■
Evening Meeting 7.00 for 7.30–9.30pm
Sue Patterson MA VetMB DVD DipECVD MRCVS
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton
MARCH – Wednesday 14
Rational management of heart failure
in practice
■
■
Evening Meeting 7.00 for 7.30–9.30pm
Prof Malcolm Cobb MA VetMB PhD MBA DVC
MRCVS
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Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby
MAY – Wednesday 23
Managing chronic diarrhoea in
practice
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Evening Meeting 7.00 for 7.30–9.30pm
David Murdoch BVMS DVR MRCVS
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton
JULY – Tuesday 18
An update on gastrointestinal
surgery
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Evening Meeting 7.00 for 7.30–9.30pm
Rachel Burrow BVetMed CertSAS CertVR DipECVS
MRCVS (TBC)
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton
SEPTEMBER – Wednesday 12
Recent advances in the management
of infectious diseases
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Evening Meeting 7.00 for 7.30–9.30pm
Prof Susan Dawson BVMS PhD MRCVS. Head of
Pitfalls in interpretation of in-house
laboratory results
Evening Meeting 7.00 for 7.30–9.30pm
Dr Joy Archer VMD MS PhD MRCPath DECVP MRCVS
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby
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NOVEMBER – Thursday 8
Interpretation of ultrasound images
Evening Meeting 7.00 for 7.30–9.30pm
Speaker TBC
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton
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DECEMBER – Wednesday 5
Evidence-based management of renal
failure
Evening Meeting 7.00 for 7.30–9.30pm
Hattie Syme (RVC) (TBC)
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby
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Prices
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School (Veterinary Science) University of Liverpool
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Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton
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Members Early Bird (2 weeks prior
to meeting): £20.00
Members post early bird: £30.00
Non-members: £50.00
companion
| 33
CPD diary
EvEning MEEting –
South WalES REgion
Wednesday 15 february
Canine mast cell tumour:
known unknowns and
unknown unknowns
Speaker: Tom Cave
Carmarthen Veterinary Centre SA31 3SA
Details from [email protected]
EvEning MEEting –
South WalES REgion
day MEEting foR nuRSES –
SCottiSh REgion
Wednesday 11 January
the cat-friendly practice
Sunday 29 January
update on infectious disease
(10am – 12pm)
Speaker: Andrea Harvey
The International Legacy Hotel, Cardiff CF15 7LD
Details from [email protected]
EvEning MEEting –
noRthERn iREland REgion
thursday 12 January
an update on stifle disease
Speaker: Bill Oxley
VSSCo, Lisburn, BT28 2SA
Details from [email protected]
EvEning MEEting –
Midland REgion
tuesday 17 January
Managing seizures (interactive)
Speaker: Mike Targett
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby DE74 2DF
Details from [email protected]
day MEEting –
noRth EaSt REgion
Sunday 22 January
Collapse conundrums
Speakers: Mike Martin and Laurent Garosi
Campanile Hotel, Bradford
Details from [email protected]
EvEning MEEting –
SouthERn REgion
tuesday 24 January
Canine and feline epilepsy:
current best practice and new
developments (includes BSava
Southern Region agM)
Speaker: Laurent Garosi
Potters Heron Hotel, Romsey, Hampshire
Details from [email protected]
day MEEting foR vEtS –
SCottiSh REgion
Sunday 29 January
a practical guide to ultrasound of
the dog (includes agM)
Speaker: Elizabeth Munro
Edinburgh Vet School
Details from [email protected]
34
| companion
Speaker: Kerry Simpson
diagnostic imaging (2pm – 4pm)
Speaker: Kimberly Palgrave
Edinburgh Vet School
Details from [email protected]
day MEEting –
SuRREy and SuSSEx REgion
tuesday 31 January
Practical abdominal radiography
Speaker: Paul Mahoney
Holiday Inn, Gatwick
Details from [email protected]
february 2012
day MEEting
tuesday 2 february
Skin lumps and bumps
Speaker: Iain Grant
The Bridge, Wetherby
Details from [email protected]
EvEning MEEting –
noRth WESt REgion
Wednesday 8 february
diabetes
Speaker: Rebecca Littler
Venue TBC (Wrexham)
Details from [email protected]
EvEning MEEting –
South WESt REgion
Wednesday 8 february
Medical work-ups in rabbits
Speaker: Richard Saunders
Canalside, Huntworth, Bridgwater,
Somerset TA7 0AJ
Details from [email protected]
EvEning MEEting –
noRthERn iREland REgion
thursday 9 february
an update on feline renal disease
Speaker: Alix McBrearty
VSSCo, Lisburn BT28 2SA
Details from [email protected]
EvEning MEEting –
SCottiSh REgion
thursday 16 february
Cardiovascular disease in dogs
including dCM
Speaker: Geoff Culshaw
Holiday Inn, Westhill, Aberdeen
Details from [email protected]
EvEning MEEting –
Midland REgion
tuesday 21 february
otitis externa
Speaker: Sue Patterson
Wolverhampton Medical Institute,
New Cross Hospital, Wolverhampton,
West Midlands WV10 0QP
Details from [email protected]
day MEEting
tuesday 21 february
BSava dispensing course
Speakers: Phil Sketchley, Steve Dean, Fred
Nind, John Hird, Pam Mosedale, Mike Jessop
Nottingham Belfry, Nottingham
Details from [email protected]
EvEning MEEting –
South WESt REgion
Wednesday 22 february
update on dM
Speaker: Grant Petrie
Best Western Gables Hotel, Falfield, Bristol
Details from [email protected]
EvEning MEEting –
SuRREy and SuSSEx REgion
Wednesday 22 february
out of step: emergency
management of canine and feline
cardiac arrhythmias in first
opinion practice
Speaker: Adrian Boswood
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from [email protected]
EvEning MEEting –
SouthERn REgion
Wednesday 22 february
a practical approach to gut stasis
in rabbits
Speaker: John Chitty
Carrington House Hotel, Knyveton Road,
Bournemouth, Dorset BH1 3QQ
Details from [email protected]
EvEning MEEting –
MEtRoPolitan REgion
EvEning MEEting –
Midland REgion
Wednesday 22 february
Basic ECg interpretation
Wednesday 14 March
Rational management of heart
failure in practice
Speakers: Simon Dennis and Charlotte Pace
University of Hertfordshire,
College Lane, Hatfield,
Hertfordshire AL10 9AB
Details from [email protected]
Speaker: Malcolm Cobb
Yew Lodge Hotel, 33 Packington Hill,
Kegworth, Derby DE74 2DF
Details from [email protected]
day MEEting –
EaSt anglia REgion
EvEning MEEting –
South WalES REgion
Sunday 26 february
neurology: the five minute
consultation
Wednesday 14 March
When it all goes wrong…
Speaker: Mark Lowrie
Venue TBC
Details from [email protected]
day MEEting –
South WESt REgion
tuesday 28 february
abdominal ultrasonography
Speakers: Nic Hayward and Esther Barrett
Charter Vets, Barnstable
Details from [email protected]
Speaker: Carol Wright
The International Legacy Hotel, Cardiff CF15 7LD
Details from [email protected]
EvEning MEEting –
SuRREy and SuSSEx REgion
Wednesday 14 March
update on rabbit medicine
and surgery
Speaker: Brigette Lord
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from [email protected]
day MEEting
March 2012
day MEEting
tuesday 6 March
thinking and doing:
animal welfare in veterinary
practice
Speaker: James Yeates
BSAVA Headquarters, Gloucester
Details from [email protected]
EvEning MEEting –
noRthERn iREland REgion
thursday 8 March
feline behaviour
Speaker: Sarah Millsopp
VSSCo, Lisburn BT28 2SA
Details from [email protected]
tuesday 20 March
the ear, the nose, the throat...
tackling tricky problems and
providing practical solutions
Speaker: Davina Anderson
Chilworth Manor, Southampton
Details from [email protected]
day MEEting – SCottiSh REgion
Sunday 25 March
dermatology: an update on
diagnostics and therapies
Speaker: Hilary Jackson
Glasgow Vet School
Details from [email protected]
april 2012
May 2012
day MEEting
thursday 3 May
the acute abdomen case: making
the right call
Speaker: Iain Grant
Ramside Hall, Durham
Details from [email protected]
day MEEting –
SouthERn REgion
thursday 10 May
ferocious felines and
confrontational canines:
unravelling the reasons and
offering practical approaches
Speaker: Sarah Heath
Venue TBC (Swindon)
Details from [email protected]
EvEning MEEting –
South WESt REgion
thursday 10 May
Raised liver enzymes: what should
i do now?
Speaker: Jill Maddison
Venue TBC (Exeter)
Details from [email protected]
day MEEting –
EaSt anglia REgion
Sunday 13 May
Breeding for the future:
reproductive management
and genetics
Speakers: Angelika von Heimendahl,
Sarah Blott, Cathryn Mellersh, Eleanor Raffan
and Jeff Sampson
Animal Health Trust, Newmarket, Suffolk
Details from [email protected]
Other upcOming
BSAVA cpD cOurSeS
See www.bsava.com for further details
■■
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day MEEting foR nuRSES
thursday 8 March
Cardiology for nurses
Speaker: Simon Dennis and Charlotte Pace
BSAVA Headquarters, Gloucester
Details from [email protected]
day MEEting
tuesday 13 March
introduction to practical cytology
Speaker: Michael Day
BSAVA Headquarters, Gloucester
Details from [email protected]
WORLD CONGRESS
11–15 April
■■
WSAVA/FECAVA/BSAVA
■■
Early Bird Discount: Register
before 12 January 2012*
■■
*Not available on some registration types
The ICC/NIA, Birmingham, UK
Email: [email protected]
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Metropolitan Region
Tuesday 15 May
Soft tissue surgery for the general
practitioner: beyond the bitch spay
South Wales Region
Wednesday 16 May
Itchy cats and dogs
Surrey and Sussex Region
Thursday 17 May
Practical dentistry
Midland Region
Wednesday 23 May
Managing chronic diarrhoea in practice
Northern Ireland Region
Friday 25 and Saturday 26 May
Endocrinology
Scottish Region
Thursday 7 June
Emergency and critical care: my patient is
bleeding, what do I do next?
companion
| 35
BSAVA Manual of
Canine and Feline
Surgical
Principles
A Foundation Manual
Edited by
Stephen Baines,
Vicky Lipscomb
and Tim Hutchinson
NEW
Available now
312 pages
BSAVA Member price: £49
Price to non-members: £75